Healthcare Provider Details

I. General information

NPI: 1992635742
Provider Name (Legal Business Name): MADELINE MAYHEW MA, LAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAIN ST STE 205
FREEHOLD NJ
07728-2554
US

IV. Provider business mailing address

1041 MARINER AVE
MANAHAWKIN NJ
08050-2335
US

V. Phone/Fax

Practice location:
  • Phone: 732-655-6331
  • Fax:
Mailing address:
  • Phone: 609-488-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00961100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: