Provider Demographics
NPI:1417183609
Name:MADDUX, JEMOUR A (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JEMOUR
Middle Name:A
Last Name:MADDUX
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIN ST # 101-1
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7113
Mailing Address - Country:US
Mailing Address - Phone:212-810-6365
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST # 101-1
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7113
Practice Address - Country:US
Practice Address - Phone:212-810-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0180691103TF0200X
NJ35SI00482600103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic