Provider Demographics
NPI:1144742560
Name:MALDONADO, LADY JUDITH (MA)
Entity Type:Individual
Prefix:MRS
First Name:LADY
Middle Name:JUDITH
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:PO BOX 10278
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0278
Mailing Address - Country:US
Mailing Address - Phone:787-638-3788
Mailing Address - Fax:787-984-2019
Practice Address - Street 1:SANTA MARIA MEDICAL BUILDING CALLE FERROCAMLL 450
Practice Address - Street 2:SUITE 203
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-984-2019
Practice Address - Fax:787-984-2019
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5481103TC1900X
PR5481103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling