Provider Demographics
NPI:1841527546
Name:RORY B. MADDEN, ED.D., PC
Entity type:Organization
Organization Name:RORY B. MADDEN, ED.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:928-699-4476
Mailing Address - Street 1:7915 N PARADISE CANYON LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-9098
Mailing Address - Country:US
Mailing Address - Phone:928-699-4476
Mailing Address - Fax:
Practice Address - Street 1:7915 N PARADISE CANYON LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-9098
Practice Address - Country:US
Practice Address - Phone:928-699-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1495261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health