Active NPI
Cheryl Maddalena, PSYD
- Psychologist
- Boise, ID
National Provider Identifier
1164782983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY - 202518
- Practice address
- 1412 W Washington St
Boise, ID 83702-5038 - Phone
- (208) 447-6835
- NPI assigned
- May 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY - 202518 | ID | Primary |
Addresses
Primary practice location
1412 W Washington St
Boise, ID 83702-5038
Mailing address
1412 W Washington St
Boise, ID 83702-5038
Phone (208) 447-6835
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 22, 2024 through Jul 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY - 202518 | ID | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358899200000",
"number": "1164782983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1412 W WASHINGTON ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837025038",
"telephone_number": "208-447-6835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 W WASHINGTON ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837025038",
"telephone_number": "208-447-6835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDALENA",
"first_name": "CHERYL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-26",
"last_updated": "2013-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ID",
"license": "PSY - 202518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.