Individual
ENOC EDUARDO MADERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
6036 BRAMBLEBERRY WAY, RALEIGH, NC 27616-6618
(919) 593-7602
Mailing address
6036 BRAMBLEBERRY WAY, RALEIGH, NC 27616-6618
(919) 593-7602
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
NC
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
01/09/2009
Last updated
06/10/2015
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