MEDICARE: MISS BRIDGETTE YVETTE MALDONADO

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	:	1942433123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRIDGETTE YVETTE MALDONADO

Provider Business Mailing Address
First Line	:	9 MIDLAND PL
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-4230
Country	:	US
Telephone Number	:	914-557-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 LINCOLN AVE
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-3912
Country	:	US
Telephone Number	:	914-632-6757
Fax Number	:

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

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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