Healthcare Provider Details

I. General information

NPI: 1902998834
Provider Name (Legal Business Name): ROSIE MALDONADO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 S 66TH ST APT 3
MILWAUKEE WI
53219-4106
US

IV. Provider business mailing address

3105 S 66TH ST APT 3
MILWAUKEE WI
53219-4106
US

V. Phone/Fax

Practice location:
  • Phone: 414-940-9456
  • Fax:
Mailing address:
  • Phone: 414-940-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4056-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4056-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: