Provider Demographics
NPI:1619063104
Name:MADSEN, JULIE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:MADSEN
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 1:82704 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-3171
Mailing Address - Country:US
Mailing Address - Phone:760-342-3330
Mailing Address - Fax:888-333-5114
Practice Address - Street 1:82704 SUTTON DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-3171
Practice Address - Country:US
Practice Address - Phone:760-342-3330
Practice Address - Fax:888-333-5114
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL139790Medicare ID - Type Unspecified
CAS00483Medicare UPIN