Healthcare Provider Details

I. General information

NPI: 1336062462
Provider Name (Legal Business Name): MADELINE VICTORIA KANE PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N PENNELL RD
MEDIA PA
19063-5520
US

IV. Provider business mailing address

136 N BREAD ST APT 407
PHILADELPHIA PA
19106-1947
US

V. Phone/Fax

Practice location:
  • Phone: 267-551-1984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: