Provider Demographics
NPI:1700268463
Name:MADDALENA, DAVID PATRICK (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PATRICK
Last Name:MADDALENA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 MIRAMONTE AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5605
Mailing Address - Country:US
Mailing Address - Phone:650-648-3623
Mailing Address - Fax:
Practice Address - Street 1:1307 S MARY AVE STE 205
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:650-648-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health