Provider Demographics
NPI:1225810328
Name:MALDONADO, JESSICA M
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MAGNOLIA AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1913
Mailing Address - Country:US
Mailing Address - Phone:862-255-0478
Mailing Address - Fax:
Practice Address - Street 1:326 MONROE AVE
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1126
Practice Address - Country:US
Practice Address - Phone:908-718-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician