Healthcare Provider Details

I. General information

NPI: 1497708309
Provider Name (Legal Business Name): ELIZABETH MALDONADO PROKAY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MILLER RD
AVON LAKE OH
44012-1004
US

IV. Provider business mailing address

765 LAFAYETTE BLVD
SHEFFIELD LAKE OH
44054-1430
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-2002
  • Fax: 440-930-2085
Mailing address:
  • Phone: 440-949-7379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0008084
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8084
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: