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General NPI Number Information
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NPI Number | 1962394403
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Entity Type | Individual
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Provider Name | DOMENICA MISHELL LOYOLA-MALDONADO
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Gender | Female
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 365 W PASSAIC ST STE 115
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3015
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Country | US
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Telephone | 201-470-7864
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Fax |
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Provider Business Mailing Address
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Address Line | 46 VAN WINKLE AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-3348
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Country | US
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Telephone | 973-930-5561
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07320900
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License Number State | NJ
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