Provider Demographics
NPI:1982304176
Name:SUMMERS, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 W WYOMING AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3749
Mailing Address - Country:US
Mailing Address - Phone:781-718-1232
Mailing Address - Fax:
Practice Address - Street 1:56 W WYOMING AVE APT 27
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3749
Practice Address - Country:US
Practice Address - Phone:781-718-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical