Provider Demographics
NPI:1083041222
Name:CAVER, MADISON RENE' (LMSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RENE'
Last Name:CAVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:LODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 BOONE ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-5908
Mailing Address - Country:US
Mailing Address - Phone:662-844-3531
Mailing Address - Fax:662-844-1757
Practice Address - Street 1:920 BOONE ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5908
Practice Address - Country:US
Practice Address - Phone:662-844-3531
Practice Address - Fax:662-844-1757
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM8774101Y00000X, 104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018203Medicaid