Provider Demographics
NPI:1083846182
Name:MALDONADO, GLORIMAR (MA)
Entity Type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 57368
Mailing Address - Street 2:SONADORA ALTA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9500
Mailing Address - Country:US
Mailing Address - Phone:787-486-0880
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 8372
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9876
Practice Address - Country:US
Practice Address - Phone:787-797-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist