Provider Demographics
NPI:1700578663
Name:POUDEL, MADISON ARIELLE
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:ARIELLE
Last Name:POUDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MADISON
Other - Middle Name:A
Other - Last Name:OECHSLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4908
Mailing Address - Country:US
Mailing Address - Phone:857-888-7614
Mailing Address - Fax:
Practice Address - Street 1:115 IRVING ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-4908
Practice Address - Country:US
Practice Address - Phone:857-888-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician