Individual
MRS. AGNES HELEN MADAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCH TECH
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8880
(209) 468-3516
Mailing address
1212 N. CALIFORNIA, STOCKTON, CA 95202
(209) 468-8880
(209) 468-3516
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT28610
CA
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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