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NPI Code Detail

MEDICARE: MADISON D'AVELLA

MEDICARE: MADISON D'AVELLA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1447181797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON D'AVELLA
Provider Business Mailing Address
First Line : 4515 BAKER ST UNIT 3
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19127-1231
Country : US
Telephone Number : 908-210-7238
Fax Number :
Provider Business Practice Location Address
First Line : 4100 MAIN ST STE 305
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19127-1623
Country : US
Telephone Number : 856-477-1201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ MADISON D'AVELLA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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