MEDICARE: MRS. DEBORAH MARIE MAULDIN LCSW

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	101YM0800X	Mental Health Counselor	LCS11654	CA

General Provider Information

NPI Number	:	1962459297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH MARIE MAULDIN LCSW

Provider Business Mailing Address
First Line	:	4132 KATELLA AVE
Second Line	:	#206
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-598-7675
Fax Number	:

Provider Business Practice Location Address
First Line	:	4132 KATELLA AVE
Second Line	:	#206
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-598-7675
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/24/2008

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