MEDICARE: WANDA MARGARITA MALDONADO M.S., L.M.H.C.

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	101YM0800X	Mental Health Counselor	MH 12067	FL
2	103T00000X	Psychologist	1260	PR

General Provider Information

NPI Number	:	1629392048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA MARGARITA MALDONADO M.S., L.M.H.C.

Provider Business Mailing Address
First Line	:	6450 ALCALDE CT UNIT 110
Second Line	:	SUITE 16
City	:	ORLANDO
State	:	FL
Zip	:	32835-3065
Country	:	US
Telephone Number	:	407-301-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 ALCALDE CT UNIT 110
Second Line	:	SUITE 16
City	:	ORLANDO
State	:	FL
Zip	:	32835-3065
Country	:	US
Telephone Number	:	407-301-8185
Fax Number	:

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	02/11/2014

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