Individual
ANTONIA MARTINA MADERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1363 WYBOO AVE, MANNING, SC 29102-7823
(203) 280-3023
Mailing address
1363 WYBOO AVE, MANNING, SC 29102-7823
(203) 280-3023
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
SC
Enumeration date
08/30/2017
Last updated
07/21/2022
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