Provider Demographics
NPI:1467839555
Name:MALDONADO, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 34TH ST
Mailing Address - Street 2:946
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10122-0049
Mailing Address - Country:US
Mailing Address - Phone:212-804-7659
Mailing Address - Fax:
Practice Address - Street 1:225 W 34TH ST
Practice Address - Street 2:946
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0049
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0937251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical