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General NPI Number Information
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NPI Number | 1053178293
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Entity Type | Individual
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Provider Name | MELINDA MALDONADO LCSW-R, CASAC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 397 BRIDGE ST
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City | BROOKLYN
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State | NY
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Zip | 11201-5292
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Country | US
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Telephone | 631-532-8353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40423
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City | GLEN OAKS
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State | NY
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Zip | 11004-0423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R080753-01
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License Number State | NY
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