Provider Demographics
NPI:1558700021
Name:MADDEN, DANIEL (BCBA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MADDEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:COLONIAL BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:22443-0602
Mailing Address - Country:US
Mailing Address - Phone:703-598-2469
Mailing Address - Fax:
Practice Address - Street 1:125 WILDER AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-2342
Practice Address - Country:US
Practice Address - Phone:703-598-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA-423103K00000X
VA0133001185103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst