Provider Demographics
NPI:1366626194
Name:MAYSONET, MADELINE I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:I
Last Name:MAYSONET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S 4TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1865
Mailing Address - Country:US
Mailing Address - Phone:570-939-2282
Mailing Address - Fax:
Practice Address - Street 1:208 S 4TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1865
Practice Address - Country:US
Practice Address - Phone:570-939-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003332103TC0700X
PAPS017316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50115485OtherCAPITAL BLUECROSS
PA002798606OtherBLUECROSS BLUESHIELD
PA272764OtherMEDICARE
PA1027947040001OtherDEPARTMENT OF PUBLIC WELFARE
PA1366626194OtherHUMANA