Provider Demographics
NPI:1679051023
Name:MADDEN, KUNIKO (MSW, QP, LCSWA)
Entity type:Individual
Prefix:
First Name:KUNIKO
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MSW, QP, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2829
Mailing Address - Country:US
Mailing Address - Phone:919-275-0133
Mailing Address - Fax:
Practice Address - Street 1:3325 DURHAM CHAPEL HILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2646
Practice Address - Country:US
Practice Address - Phone:919-451-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0115051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical