Provider Demographics
NPI:1619682465
Name:KANE, MADISON (LGPC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S EDEN ST APT 714
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2837
Mailing Address - Country:US
Mailing Address - Phone:203-253-9076
Mailing Address - Fax:
Practice Address - Street 1:777 S EDEN ST APT 714
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2837
Practice Address - Country:US
Practice Address - Phone:203-253-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional