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General NPI Number Information
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NPI Number | 1972098226
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Entity Type | Individual
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Provider Name | MADELINE MULDOON LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 1931 FRANKFORT AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206
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Country | US
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Telephone | 502-644-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 1226 BELMAR DR
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City | LOUISVILLE
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State | KY
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Zip | 40213-1757
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Country | US
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Telephone | 502-644-2346
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 241341
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 99087141A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 254414
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License Number State | KY
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