Healthcare Provider Details

I. General information

NPI: 1740004456
Provider Name (Legal Business Name): CYBELLE PACHECO-MALDONADO PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

2628 S MILFORD RD
HIGHLAND MI
48357-4938
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax: 810-215-1334
Mailing address:
  • Phone: 517-492-0517
  • Fax: 810-215-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019596
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: