Healthcare Provider Details

I. General information

NPI: 1578684320
Provider Name (Legal Business Name): MADELINE MALDONADO LCSW-R, LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MIDLAND AVENUE APT 10G
BRONXVILLE NY
10708-6428
US

IV. Provider business mailing address

1160 MIDLAND AVENUE APT 10G
BRONXVILLE NY
10708-6428
US

V. Phone/Fax

Practice location:
  • Phone: 917-880-8193
  • Fax: 914-346-5031
Mailing address:
  • Phone: 917-880-8193
  • Fax: 914-346-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3937
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010001491
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP062204-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: