Provider Demographics
NPI:1346266582
Name:MADIOU, DOLORES (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:MADIOU
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 1:4623 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4914
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:10451 TWIN RIVERS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2388
Practice Address - Country:US
Practice Address - Phone:410-997-3557
Practice Address - Fax:410-964-1791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD012621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD399170OtherTRICARE
MD226092OtherKAISER
MD239330-000OtherMAGELLAN HEALTHCARE
MDPVP134855OtherAPS HEALTHCARE
MD7618409OtherAETNA BEHAVIORAL HEALTH
MD280361OtherMAMSI
MD417290OtherBCBS
MD492610200Medicaid
MD11249314OtherCAQH
MDT541 0025OtherBCBS-DC
MD280361OtherMAMSI