Provider Demographics
NPI:1528871753
Name:MALDONADO, GRETCHKA
Entity type:Individual
Prefix:
First Name:GRETCHKA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 NATURE TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:850-807-5299
Practice Address - Street 1:1538 NATURE TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3800
Practice Address - Country:US
Practice Address - Phone:407-818-7035
Practice Address - Fax:850-807-5299
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical