Provider Demographics
NPI:1336294461
Name:MALDONADO, JAIME
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W SAHARA AVE # 479
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5858
Mailing Address - Country:US
Mailing Address - Phone:413-626-6225
Mailing Address - Fax:702-982-3260
Practice Address - Street 1:2701 RENWICK CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-0405
Practice Address - Country:US
Practice Address - Phone:413-626-6225
Practice Address - Fax:702-982-3260
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13320101YA0400X
MA1203821041C0700X
NV7769-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)