MEDICARE: MADELINE ALTABE PHD

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	103TC0700X	Clinical Psychologist	PY4848	FL
2	103TA0700X	Adult Development & Aging Psychologist	PY4848	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59354	OTHER		BC/BS FLORIDA

General Provider Information

NPI Number	:	1417948993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE ALTABE PHD

Provider Business Mailing Address
First Line	:	PO BOX 80985
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30366-0985
Country	:	US
Telephone Number	:	404-941-6402
Fax Number	:

Provider Business Practice Location Address
First Line	:	2972 MEMORIAL DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-3541
Country	:	US
Telephone Number	:	404-941-6402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/03/2026

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Directions to “ MADELINE ALTABE PHD” Practice Location

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