Provider Demographics
NPI:1235880774
Name:MALDONADO-JARDIEU, MELISSA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:MALDONADO-JARDIEU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:32 GREENMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1004
Mailing Address - Country:US
Mailing Address - Phone:315-542-4810
Mailing Address - Fax:
Practice Address - Street 1:UTICA CITY SCHOOL DISTRICT
Practice Address - Street 2:929 YORK ST.
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-368-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088220-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical