MEDICARE: MADDIE BUDREAU THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1093661506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADDIE BUDREAU THERAPY LLC

Provider Business Mailing Address
First Line	:	1207 CLYMER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2642
Country	:	US
Telephone Number	:	703-380-4776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 CLYMER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2642
Country	:	US
Telephone Number	:	703-380-4776
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MADELEINE BUDREAU
Credential	:	LCSW
Telephone Number	:	703-380-4776

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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