Provider Demographics
NPI:1326592916
Name:NEVES, MADELYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:
Last Name:NEVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:A
Other - Last Name:JOHNSON-NEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2341 E SOUTH MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-8133
Mailing Address - Country:US
Mailing Address - Phone:602-550-2476
Mailing Address - Fax:
Practice Address - Street 1:2341 E SOUTH MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8133
Practice Address - Country:US
Practice Address - Phone:602-550-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health