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General NPI Number Information
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NPI Number | 1427399377
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Entity Type | Individual
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Provider Name | RAEQUEL ALLYSSA MADARA PMHNP, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 527 E LANCASTER AVE
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City | SHILLINGTON
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State | PA
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Zip | 19607-1364
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Country | US
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Telephone | 610-796-8110
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Fax | 610-796-9130
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Provider Business Mailing Address
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Address Line | 145 E GREENWOOD AVE
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City | LANSDOWNE
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State | PA
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Zip | 19050-1621
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Country | US
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Telephone | 610-368-7737
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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 | CW017538
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP032464
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License Number State | PA
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