Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 4429 | OH |
Y | 103TC0700X | Clinical Psychologist | 4429 | OH |
N | 102L00000X | Psychologist | 4429 | OH |
N | 103T00000X | Psychologist | 4429 | OH |
N | 103TR0400X | Rehabilitation Psychologist | 4429 | OH |
NPI | 1356350037 |
---|---|
Provider Name | Dr. Jeffrey Madden |
First Address | Dublin, OH 43016-4141 |
Second Address | Columbus, OH 43214-3912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 28/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0846259 | (05) | OH |