Provider Demographics
NPI:1265453732
Name:SCHRADER, MADELYN B (RN MA LPC)
Entity type:Individual
Prefix:MS
First Name:MADELYN
Middle Name:B
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:RN MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 CARLISLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5606
Mailing Address - Country:US
Mailing Address - Phone:703-402-3527
Mailing Address - Fax:703-471-0365
Practice Address - Street 1:429 CARLISLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5606
Practice Address - Country:US
Practice Address - Phone:703-866-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004204101YP2500X
VA0001110378163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult