Provider Demographics
NPI:1134204902
Name:MADIGAN, LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:LEE
Other - Last Name:MADIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2220 E FRUIT ST
Mailing Address - Street 2:STE 109
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-667-3955
Mailing Address - Fax:714-541-8256
Practice Address - Street 1:2220 E FRUIT ST
Practice Address - Street 2:STE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-667-3955
Practice Address - Fax:714-541-8256
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10362103TC0700X
CA15440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist