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General NPI Number Information
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NPI Number | 1730395948
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Entity Type | Individual
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Provider Name | CARLA ROSE MADDOX LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | BUILDING 8156, COMANCHE BLVD, URLAS KASERNE
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City | APO AE
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State | BAVARIA
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Zip | 09250
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Country | DE
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Telephone | 254-338-4862
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 454, BOX 2124
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City | APO
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State | AE
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Zip | 09250
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Country | DE
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Telephone |
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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 | 29819
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License Number State | TX
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