Provider Demographics
NPI:1700608783
Name:MAZE, MADISON NAYLOR (CT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NAYLOR
Last Name:MAZE
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:NAYLOR
Other - Last Name:SEABURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8253 TRIBUTARY LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9444
Mailing Address - Country:US
Mailing Address - Phone:614-561-0407
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD STE 100A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7007
Practice Address - Country:US
Practice Address - Phone:614-538-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305277-TRNE101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor