Provider Demographics
NPI:1528131877
Name:MADISON, NORMA DOZIER (PSYD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:DOZIER
Last Name:MADISON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19320 ELDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5321
Mailing Address - Country:US
Mailing Address - Phone:248-747-3023
Mailing Address - Fax:313-596-4773
Practice Address - Street 1:17117 W 9 MILE RD
Practice Address - Street 2:SUITE 1325
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4602
Practice Address - Country:US
Practice Address - Phone:248-747-3023
Practice Address - Fax:313-596-4773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010162781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP15750Medicare ID - Type UnspecifiedMEDICARE