Provider Demographics
NPI:1407239536
Name:MALDONADO, ASUCENA (BCBA)
Entity Type:Individual
Prefix:
First Name:ASUCENA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:6624 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-9657
Mailing Address - Country:US
Mailing Address - Phone:209-326-0989
Mailing Address - Fax:
Practice Address - Street 1:6624 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:CA
Practice Address - Zip Code:95388-9657
Practice Address - Country:US
Practice Address - Phone:209-326-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21434103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst