Healthcare Provider Details

I. General information

NPI: 1578061412
Provider Name (Legal Business Name): DRA CARMEN L MALDONADO TRINIDAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B16 STE 2 CALLE MARGINAL URB FLAMBOYAN
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 464
MANATI PR
00674-0464
US

V. Phone/Fax

Practice location:
  • Phone: 787-529-6055
  • Fax: 787-369-7632
Mailing address:
  • Phone: 787-529-6055
  • Fax: 787-369-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2666
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CARMEN L MALDONADO TRINIDAD
Title or Position: CLINICAL PSYCHOLOGIST / OWNER
Credential: BAED; MAED; MAR;PSYD
Phone: 787-529-6055