MEDICARE: MS. MARILYN MALDONADO LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	100806	NY

General Provider Information

NPI Number	:	1134639602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN MALDONADO LMSW

Provider Business Mailing Address
First Line	:	78-08 151 AVENUE
Second Line	:	2ND FLOOR
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414
Country	:	US
Telephone Number	:	347-351-3919
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 JUNCTION BLVD
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-2121
Country	:	US
Telephone Number	:	917-995-3773
Fax Number	:	212-656-1412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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