Provider Demographics
NPI:1952457186
Name:MADDERN, CHERYL JEANNE (MFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JEANNE
Last Name:MADDERN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 LOMITA BLVD SPC 67
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-4603
Mailing Address - Country:US
Mailing Address - Phone:310-283-6375
Mailing Address - Fax:310-257-5753
Practice Address - Street 1:3333 SYPARK DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-257-5750
Practice Address - Fax:310-257-5753
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist