Provider Demographics
NPI:1215031406
Name:MALDONADO, LORETTO JOAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LORETTO
Middle Name:JOAN
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 CAMINO GARDENS BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-367-9997
Mailing Address - Fax:561-391-3574
Practice Address - Street 1:398 CAMINO GARDENS BLVD
Practice Address - Street 2:STE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-367-9997
Practice Address - Fax:561-391-3574
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
73205Medicare ID - Type Unspecified