Provider Demographics
NPI:1134639602
Name:MALDONADO, MARILYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-08 151 AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:347-351-3919
Mailing Address - Fax:
Practice Address - Street 1:4035 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2121
Practice Address - Country:US
Practice Address - Phone:917-995-3773
Practice Address - Fax:212-656-1412
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1008061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical