Provider Demographics
NPI:1316020340
Name:MADOF, FRANK (PHD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MADOF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 DRAYTON LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3101
Mailing Address - Country:US
Mailing Address - Phone:215-331-3200
Mailing Address - Fax:
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-331-3200
Practice Address - Fax:215-331-3977
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002590L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20375OtherHIGHMARK
PA0049131000OtherPERSONAL CHOICE