Provider Demographics
NPI:1760750285
Name:MADDOCK, MICHAEL (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MADDOCK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 SHERWOOD TERRACE DR
Mailing Address - Street 2:303
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7402
Mailing Address - Country:US
Mailing Address - Phone:407-346-6030
Mailing Address - Fax:
Practice Address - Street 1:729 SHERWOOD TERRACE DR
Practice Address - Street 2:303
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7402
Practice Address - Country:US
Practice Address - Phone:407-346-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health