Healthcare Provider Details

I. General information

NPI: 1598788259
Provider Name (Legal Business Name): CHRISTOPHER M. MADDEN MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PORTLAND ROAD
KENNEBUNK ME
04043-6656
US

IV. Provider business mailing address

58 PORTLAND ROAD
KENNEBUNK ME
04043-6656
US

V. Phone/Fax

Practice location:
  • Phone: 207-205-2265
  • Fax:
Mailing address:
  • Phone: 207-205-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7507
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: