Provider Demographics
NPI:1992240352
Name:HARVEY, MADALYN
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 S STATE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1653
Mailing Address - Country:US
Mailing Address - Phone:734-713-9500
Mailing Address - Fax:734-902-6029
Practice Address - Street 1:3135 S STATE ST STE 108
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1653
Practice Address - Country:US
Practice Address - Phone:734-713-9500
Practice Address - Fax:734-902-6029
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6801102191104100000X
390200000X
MI68011069951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program