Provider Demographics
NPI:1699120568
Name:MALDONADO, SAMEL (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMEL
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTH AVE
Mailing Address - Street 2:#22D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2404
Mailing Address - Country:US
Mailing Address - Phone:201-410-7376
Mailing Address - Fax:
Practice Address - Street 1:555 NORTH AVE
Practice Address - Street 2:#22D
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2404
Practice Address - Country:US
Practice Address - Phone:201-364-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral