Provider Demographics
NPI:1427832823
Name:MALDONADO, MICHELLE (MHC-LP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 227TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6722
Mailing Address - Country:US
Mailing Address - Phone:646-483-6963
Mailing Address - Fax:
Practice Address - Street 1:108 W 227TH ST APT 3B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6722
Practice Address - Country:US
Practice Address - Phone:646-483-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP119659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health