Provider Demographics
NPI:1275249955
Name:MALDONADO, NICHOLE (MSED)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 JACKSON AVE APT 2007
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-9435
Mailing Address - Country:US
Mailing Address - Phone:917-371-7657
Mailing Address - Fax:
Practice Address - Street 1:2244 JACKSON AVE APT 2007
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-9435
Practice Address - Country:US
Practice Address - Phone:917-371-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician