Healthcare Provider Details

I. General information

NPI: 1760133888
Provider Name (Legal Business Name): ISSECHELIZ MALDONADO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SOCKANOSSET CROSS RD STE 206
CRANSTON RI
02920-5558
US

IV. Provider business mailing address

53 LANCASHIRE ST
PROVIDENCE RI
02908-1610
US

V. Phone/Fax

Practice location:
  • Phone: 401-830-9899
  • Fax:
Mailing address:
  • Phone: 401-288-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04936
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: