Provider Demographics
NPI:1649773748
Name:SAXE, MADELEINE SUZANNE (LMFT)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:SUZANNE
Last Name:SAXE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WASHINGTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4202
Mailing Address - Country:US
Mailing Address - Phone:917-701-0051
Mailing Address - Fax:
Practice Address - Street 1:2001 WILSHIRE BLVD STE 505
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5640
Practice Address - Country:US
Practice Address - Phone:917-701-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist