Provider Demographics
NPI:1275667206
Name:MADDEN, MARIE LOUISE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LOUISE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:SUITE D-104
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4161
Mailing Address - Country:US
Mailing Address - Phone:401-295-5575
Mailing Address - Fax:401-295-5572
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:SUITE D-104
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-295-5575
Practice Address - Fax:401-295-5572
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW004171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical