Provider Demographics
NPI:1093388753
Name:MALDONADO, SARYVETTE (LCDA)
Entity Type:Individual
Prefix:
First Name:SARYVETTE
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:SARYVETTE
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:COND RIVERSIDE PLAZA APT 10F
Mailing Address - Street 2:CALLE STA CRUZ 74
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7069
Mailing Address - Country:US
Mailing Address - Phone:787-310-5328
Mailing Address - Fax:
Practice Address - Street 1:COND RIVERSIDE PLAZA APT 10F
Practice Address - Street 2:CALLE STA CRUZ 74
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7069
Practice Address - Country:US
Practice Address - Phone:787-310-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7015103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4444762OtherDRIVER ID