Provider Demographics
NPI:1831130558
Name:MADDEN-ECHOLS, MARY E (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:MADDEN-ECHOLS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WAMPANOAG DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-3608
Mailing Address - Country:US
Mailing Address - Phone:401-683-5386
Mailing Address - Fax:401-683-0232
Practice Address - Street 1:4 WAMPANOAG DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-3608
Practice Address - Country:US
Practice Address - Phone:401-683-5386
Practice Address - Fax:401-683-0232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical