Basic Information
| Provider Information | |||||||||
| NPI: | 1477658896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | MADELON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 FLORENCE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178684460 | ||||||||
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| Practice Location | |||||||||
| Address1: | 172 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787444033 | ||||||||
| FaxNumber: | 9787404996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 7818 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.