MEDICARE: MRS. LAURA MALDONADO ALICEA MS, BCBA

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	101Y00000X	Counselor
2	103K00000X	Behavior Analyst		PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	M18463	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417323437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA MALDONADO ALICEA MS, BCBA

Provider Business Mailing Address
First Line	:	120 MAPLE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-2203
Country	:	US
Telephone Number	:	413-846-0445
Fax Number	:

Provider Business Practice Location Address
First Line	:	C31 AVE APOLO ESQ RUFINO RODRIGUEZ
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	787-221-0874
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	12/04/2025

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