Provider Demographics
NPI:1366255317
Name:MADHERE, YOVANNA
Entity type:Individual
Prefix:
First Name:YOVANNA
Middle Name:
Last Name:MADHERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 CARTHAGE RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6014
Mailing Address - Country:US
Mailing Address - Phone:786-486-2789
Mailing Address - Fax:
Practice Address - Street 1:2115 CARTHAGE RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6014
Practice Address - Country:US
Practice Address - Phone:786-486-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0122431041C0700X
DCLG2000032341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical