Provider Demographics
NPI:1679564868
Name:MADAUS, BARBARA (M ED LP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MADAUS
Suffix:
Gender:F
Credentials:M ED LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 MCKNIGHT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3415
Mailing Address - Country:US
Mailing Address - Phone:412-364-4291
Mailing Address - Fax:412-241-0739
Practice Address - Street 1:4721 MCKNIGHT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3415
Practice Address - Country:US
Practice Address - Phone:412-364-4291
Practice Address - Fax:412-241-0739
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007407L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01739400OtherMEDICAL ASSISTANCE
PA01739400OtherMEDICAL ASSISTANCE
PA643019Medicare ID - Type Unspecified