Provider Demographics
NPI:1851378483
Name:MADERSON, PATRICIA F (LISW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:F
Last Name:MADERSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-3449
Mailing Address - Country:US
Mailing Address - Phone:843-345-9122
Mailing Address - Fax:
Practice Address - Street 1:121 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-3449
Practice Address - Country:US
Practice Address - Phone:843-345-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-1068565OtherEIN