Healthcare Provider Details

I. General information

NPI: 1699120568
Provider Name (Legal Business Name): SAMUEL MALDONADO PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 DORCHESTER LN APT D
NEW MILFORD NJ
07646-3090
US

IV. Provider business mailing address

4060 ARBOR MILL CIR
ORANGE PARK FL
32065-3202
US

V. Phone/Fax

Practice location:
  • Phone: 201-364-8474
  • Fax:
Mailing address:
  • Phone: 201-410-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number37PC00744200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: