Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS007168L | PA |
NPI | 1043319825 |
---|---|
Provider Name | Dr. Judith Pool Madison |
First Address | Northampton, PA 18067-9535 |
Second Address | Northampton, PA 18067-9535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01080301 | CAPITAL BLUE CROSS (01) | PA |
02624300 | CAPITAL BLUE CROSS (01) | PA |
50045686 | CAPITAL BLUE CROSS (01) | PA |