Provider Demographics
NPI:1356178867
Name:CORREIA, MADISON MARIE (BS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:CORREIA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3106
Mailing Address - Country:US
Mailing Address - Phone:774-644-4627
Mailing Address - Fax:
Practice Address - Street 1:651 ORCHARD ST STE 202
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-1052
Practice Address - Country:US
Practice Address - Phone:774-202-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health