Provider Demographics
NPI:1497005797
Name:MADDEN, COLLEEN ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:MADDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MIFFLIN PL STE 400
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4946
Mailing Address - Country:US
Mailing Address - Phone:617-802-7478
Mailing Address - Fax:617-798-1757
Practice Address - Street 1:1 MIFFLIN PL STE 400
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4946
Practice Address - Country:US
Practice Address - Phone:617-802-7478
Practice Address - Fax:617-798-1757
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MARN2299366363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor