Provider Demographics
NPI:1558901371
Name:RIVERA-MALDONADO, MAILY DENNISSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAILY
Middle Name:DENNISSE
Last Name:RIVERA-MALDONADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE DOMENECH STE 509
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3705
Mailing Address - Country:US
Mailing Address - Phone:787-998-1297
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH STE 509
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3705
Practice Address - Country:US
Practice Address - Phone:787-998-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical