Provider Demographics
NPI:1841413572
Name:MADY, JAMES JOHN JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:MADY
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2323 S BABCOCK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5300
Mailing Address - Country:US
Mailing Address - Phone:321-802-3430
Mailing Address - Fax:321-802-6031
Practice Address - Street 1:2323 S BABCOCK ST
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5300
Practice Address - Country:US
Practice Address - Phone:321-802-3430
Practice Address - Fax:321-802-6031
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0133Medicaid