Provider Demographics
NPI:1033953310
Name:LARDY, MADISON PAIGE (LCSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:LARDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 QUARRY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6995
Mailing Address - Country:US
Mailing Address - Phone:817-846-2367
Mailing Address - Fax:
Practice Address - Street 1:4505 QUARRY CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6995
Practice Address - Country:US
Practice Address - Phone:817-846-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical