Provider Demographics
NPI:1497049035
Name:MADIGAN, ALYSON LEIGH (PSYD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:LEIGH
Last Name:MADIGAN
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 1:1250 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1002
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:10333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5808
Practice Address - Country:US
Practice Address - Phone:805-468-2998
Practice Address - Fax:805-468-2918
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical