Provider Demographics
NPI:1730329947
Name:MADSON COX, POLLY (LCSW)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:MADSON COX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COLUMBIA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6357
Mailing Address - Country:US
Mailing Address - Phone:207-942-8200
Mailing Address - Fax:
Practice Address - Street 1:82 COLUMBIA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6357
Practice Address - Country:US
Practice Address - Phone:207-942-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical