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General NPI Number Information
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NPI Number | 1205264058
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Entity Type | Individual
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Provider Name | ROBERT MADDOX LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 421 5TH AVE NORTH EMPLOYEE HEALTH CLINIC, 2ND FLOOR CENTRAL SERVICES BLDG
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City | NASHVILLE
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State | TN
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Zip | 37743
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Country | US
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Telephone | 615-478-2765
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Fax |
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Provider Business Mailing Address
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Address Line | 212 HERBERT CT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7653
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Country | US
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Telephone | 615-478-2765
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | IP 68
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License Number State | TN
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