=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831314079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINE MADDEN, MFT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2007
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 EAST COLORADO BLVD SUITE 205
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-644-1609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 EAST COLORADO BLVD SUITE 205
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-644-1609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CAROLINE MADDEN
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 626-644-1609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 40947
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------