Healthcare Provider Details

I. General information

NPI: 1962200535
Provider Name (Legal Business Name): JULIA MARIE MADICK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 BRADENTON AVE STE 110
DUBLIN OH
43017-3551
US

IV. Provider business mailing address

155 CARTER CIR
YOUNGSTOWN OH
44512-6631
US

V. Phone/Fax

Practice location:
  • Phone: 614-515-2500
  • Fax:
Mailing address:
  • Phone: 330-519-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039425
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.531079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: