Provider Demographics
NPI:1558822239
Name:FUDALI, MADELINE ANN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ANN
Last Name:FUDALI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 SURREY PT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3277
Mailing Address - Country:US
Mailing Address - Phone:678-314-4920
Mailing Address - Fax:
Practice Address - Street 1:37 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4906
Practice Address - Country:US
Practice Address - Phone:678-619-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11934426103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst