Provider Demographics
NPI:1306829742
Name:MADEO, CHRISTINE ERIKSEN (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ERIKSEN
Last Name:MADEO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9349 STOTTLEMEYER RD
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1533
Mailing Address - Country:US
Mailing Address - Phone:301-998-4050
Mailing Address - Fax:
Practice Address - Street 1:1190 MOUNT AETNA RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6833
Practice Address - Country:US
Practice Address - Phone:301-988-4050
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD286SMedicare ID - Type Unspecified