Provider Demographics
NPI:1235331760
Name:MADERE, CYNTHIA LOUISE (COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:MADERE
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1235
Mailing Address - Country:US
Mailing Address - Phone:323-506-8675
Mailing Address - Fax:
Practice Address - Street 1:5015 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4127
Practice Address - Country:US
Practice Address - Phone:323-653-1677
Practice Address - Fax:323-936-9435
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM0907151953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM0907151953OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR