Provider Demographics
NPI:1376602664
Name:WADDELL, MADELEINE A (MA MFT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:A
Last Name:WADDELL
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 MARKET ST
Mailing Address - Street 2:#407
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-642-6656
Mailing Address - Fax:805-642-4175
Practice Address - Street 1:4482 MARKET ST
Practice Address - Street 2:#407
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-642-6656
Practice Address - Fax:805-642-4175
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist