Provider Demographics
NPI:1740675875
Name:MADSEN, SOPHIE ALEXANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ALEXANDRA
Last Name:MADSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-1163
Mailing Address - Country:US
Mailing Address - Phone:530-404-5193
Mailing Address - Fax:
Practice Address - Street 1:468 MANZANITA AVE STE 7
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1358
Practice Address - Country:US
Practice Address - Phone:530-934-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62318101YM0800X
CA885211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health