Provider Demographics
NPI:1437209699
Name:MADACK, CAROLYN C (MED)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:C
Last Name:MADACK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 WESTGATE DR
Mailing Address - Street 2:STE. 300
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7480
Mailing Address - Country:US
Mailing Address - Phone:610-332-1705
Mailing Address - Fax:610-332-1707
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:STE. 300
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:610-332-1705
Practice Address - Fax:610-332-1707
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007613-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling