Provider Demographics
NPI:1023210713
Name:MAULDEN, ANTHONY WAYNE (BS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:MAULDEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7604
Mailing Address - Country:US
Mailing Address - Phone:505-382-5720
Mailing Address - Fax:505-271-4957
Practice Address - Street 1:8401 CONSTITUTION AVE NE STE 215
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7604
Practice Address - Country:US
Practice Address - Phone:505-382-5720
Practice Address - Fax:505-271-4957
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator