Provider Demographics
NPI:1659479780
Name:MADISON, JANET M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:MADISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 DONNA DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6188
Mailing Address - Country:US
Mailing Address - Phone:737-425-5050
Mailing Address - Fax:737-425-1389
Practice Address - Street 1:1630 DONNA DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6188
Practice Address - Country:US
Practice Address - Phone:737-425-5050
Practice Address - Fax:737-425-1389
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001918104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO81397MOtherOPTIMA
VA093526OtherANTHEM
VA004945395OtherVA PREMIER
VA004945395Medicaid
VA139821OtherANTHEM
VA008915385Medicaid
VAO86164OtherSENTARA
VA66488000OtherMAGLLAN
VA004945395OtherVA PREMIER
VA008915385Medicaid