Healthcare Provider Details

I. General information

NPI: 1285270181
Provider Name (Legal Business Name): VERONICA MALDONADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 N RAINBOW PARK DR
WASILLA AK
99623-9241
US

IV. Provider business mailing address

1051 N RAINBOW PARK DR
WASILLA AK
99623-9241
US

V. Phone/Fax

Practice location:
  • Phone: 907-741-1714
  • Fax: 907-376-3520
Mailing address:
  • Phone: 907-376-3530
  • Fax: 907-376-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-79693
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW136293
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number172300
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: