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General NPI Number Information
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NPI Number | 1336294461
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Entity Type | Individual
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Provider Name | MR. JAIME MALDONADO
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 2701 RENWICK CIR
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City | LAS VEGAS
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State | NV
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Zip | 89117-0405
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Country | US
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Telephone | 413-626-6225
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Fax | 702-982-3260
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Provider Business Mailing Address
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Address Line | 8635 W SAHARA AVE # 479
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City | LAS VEGAS
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State | NV
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Zip | 89117-5858
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Country | US
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Telephone | 413-626-6225
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Fax | 702-982-3260
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13320
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 120382
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7769-C
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License Number State | NV
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