Provider Demographics
NPI:1205629268
Name:DEAN, MADISON L
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:L
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MCLANE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-4854
Mailing Address - Country:US
Mailing Address - Phone:302-757-4068
Mailing Address - Fax:
Practice Address - Street 1:53 DON KNOTTS BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-6838
Practice Address - Country:US
Practice Address - Phone:304-826-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)