Healthcare Provider Details

I. General information

NPI: 1821903287
Provider Name (Legal Business Name): MDC COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ISSECHELIZ MALDONADO
Title or Position: OWNER
Credential: LICSW
Phone: 401-288-2973