Provider Demographics
NPI:1093012437
Name:MADDEN, KENNETH C JR (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:MADDEN
Suffix:JR
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1735
Mailing Address - Country:US
Mailing Address - Phone:302-684-4950
Mailing Address - Fax:302-684-8931
Practice Address - Street 1:1270 KINGS HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1735
Practice Address - Country:US
Practice Address - Phone:302-684-4950
Practice Address - Fax:302-684-8931
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE28562103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool