Healthcare Provider Details

I. General information

NPI: 1164159869
Provider Name (Legal Business Name): JOVANNA MALDONADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS WAY
AVENAL CA
93204-9708
US

IV. Provider business mailing address

4741 JOAQUIN AVE
CLOVIS CA
93619-8511
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-0587
  • Fax:
Mailing address:
  • Phone: 559-300-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: