MEDICARE: MR. JAIME MALDONADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13320	MA
2	1041C0700X	Clinical Social Worker	120382	MA
3	1041C0700X	Clinical Social Worker	7769-C	NV

General Provider Information

NPI Number	:	1336294461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAIME MALDONADO

Provider Business Mailing Address
First Line	:	8635 W SAHARA AVE # 479
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5858
Country	:	US
Telephone Number	:	413-626-6225
Fax Number	:	702-982-3260

Provider Business Practice Location Address
First Line	:	2701 RENWICK CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0405
Country	:	US
Telephone Number	:	413-626-6225
Fax Number	:	702-982-3260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/04/2018

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