Healthcare Provider Details

I. General information

NPI: 1871135749
Provider Name (Legal Business Name): WALESKA MALDONADO PH.D, MRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2019
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE ESTEBAN PADILLA
BAYAMON PR
00959-6705
US

IV. Provider business mailing address

HC 91 BOX 9178
VEGA ALTA PR
00692-9675
US

V. Phone/Fax

Practice location:
  • Phone: 939-248-3845
  • Fax:
Mailing address:
  • Phone: 939-248-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1363
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6664
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: