Provider Demographics
NPI:1568970879
Name:MADDALO, MARIA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MADDALO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:FRAGNITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-0836
Mailing Address - Country:US
Mailing Address - Phone:267-652-0203
Mailing Address - Fax:
Practice Address - Street 1:996 OLD EAGLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1806
Practice Address - Country:US
Practice Address - Phone:610-616-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist