Provider Demographics
NPI:1700592284
Name:MADNICK, DEBORAH (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MADNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:GOLDSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CHESLEY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1760
Mailing Address - Country:US
Mailing Address - Phone:610-529-1875
Mailing Address - Fax:
Practice Address - Street 1:107 CHESLEY DR STE 2
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1760
Practice Address - Country:US
Practice Address - Phone:610-529-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS09803103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist