Provider Demographics
NPI:1336654987
Name:MALDONADO, PAULETTE GIBBONS (MS, LMHC, MCAP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:GIBBONS
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MS, LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 RADIUS DR APT 604
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7710
Mailing Address - Country:US
Mailing Address - Phone:786-374-8100
Mailing Address - Fax:
Practice Address - Street 1:1830 RADIUS DR APT 604
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7710
Practice Address - Country:US
Practice Address - Phone:786-374-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health