Healthcare Provider Details

I. General information

NPI: 1952457186
Provider Name (Legal Business Name): CHERYL JEANNE MADDERN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SYPARK DRIVE SUITE 220
TORRANCE CA
90505
US

IV. Provider business mailing address

1065 LOMITA BLVD SPC 67
HARBOR CITY CA
90710-4603
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-5750
  • Fax: 310-257-5753
Mailing address:
  • Phone: 310-283-6375
  • Fax: 310-257-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number36435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: