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General NPI Number Information
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NPI Number | 1144098807
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Entity Type | Individual
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Provider Name | MADELEINE HARVEY
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Gender | Female
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 1201 PUERTA DEL SOL
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6310
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Country | US
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Telephone | 949-329-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 W COVINA BLVD STE 120
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City | SAN DIMAS
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State | CA
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Zip | 91773-3205
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Country | US
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Telephone | 909-979-3722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 135471
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License Number State | CA
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