Individual
MRS. RAEQUEL ALLYSSA MADARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP, LCSW
Contact information
Practice address
527 E LANCASTER AVE, SHILLINGTON, PA 19607-1364
(610) 796-8110
(610) 796-9130
Mailing address
145 E GREENWOOD AVE, LANSDOWNE, PA 19050-1621
(610) 368-7737
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CW017538
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP032464
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104516608-0001
—
PA
Enumeration date
03/01/2013
Last updated
09/19/2025
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