Provider Demographics
NPI:1043319825
Name:MADISON, JUDITH POOL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:POOL
Last Name:MADISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:IRENE
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4008 FRIARS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-9535
Mailing Address - Country:US
Mailing Address - Phone:610-703-6993
Mailing Address - Fax:610-767-4170
Practice Address - Street 1:4008 FRIARS VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-9535
Practice Address - Country:US
Practice Address - Phone:610-703-6993
Practice Address - Fax:610-767-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007168L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50045686OtherCAPITAL BLUE CROSS
PA01080301OtherCAPITAL BLUE CROSS
PA02624300OtherCAPITAL BLUE CROSS