Healthcare Provider Details

I. General information

NPI: 1700547312
Provider Name (Legal Business Name): MADISON CARMEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LAFAYETTE ST STE 110
FORT WAYNE IN
46806-1100
US

IV. Provider business mailing address

2700 LAFAYETTE ST STE 110
FORT WAYNE IN
46806-1100
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-0780
  • Fax: 260-266-0785
Mailing address:
  • Phone: 260-266-0780
  • Fax: 260-266-0785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33011921A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: