Provider Demographics
NPI:1871718320
Name:MADDEN, KATHLEEN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 KINGS HIGHWAY
Mailing Address - Street 2:SUITE 101B CAPE COUNSELING & WELLNESS
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-644-4323
Mailing Address - Fax:302-644-4323
Practice Address - Street 1:750 KINGS HIGHWAY
Practice Address - Street 2:SUITE 101B CAPE COUNSELING & WELLNESS
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-4323
Practice Address - Fax:302-644-4323
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00005271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030145Medicaid