MEDICARE: KATIE MALDONADO LCSW

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

General Provider Information

NPI Number	:	1649913864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATIE MALDONADO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1925
Second Line	:
City	:	LINCOLN
State	:	CA
Zip	:	95648-1447
Country	:	US
Telephone Number	:	916-884-1653
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 LIBERTY WAY STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3466
Country	:	US
Telephone Number	:	804-993-4769
Fax Number	:	916-619-1942

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KATIE ELIZABETH MALDONADO
Credential	:	LCSW
Telephone Number	:	804-993-4769

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/14/2026

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