Provider Demographics
NPI:1861223638
Name:KING, MADELINE R (PSYD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:R
Last Name:KING
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 1:3304 N HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8128
Mailing Address - Country:US
Mailing Address - Phone:301-788-9058
Mailing Address - Fax:
Practice Address - Street 1:6125 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3901
Practice Address - Country:US
Practice Address - Phone:301-581-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5769103G00000X
MD07252103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist