Provider Demographics
NPI:1568614857
Name:MALDONADO TRINIDAD, CARMEN LIDIA (PSYD, MAED, MAR,)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LIDIA
Last Name:MALDONADO TRINIDAD
Suffix:
Gender:F
Credentials:PSYD, MAED, MAR,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0464
Mailing Address - Country:US
Mailing Address - Phone:787-529-6055
Mailing Address - Fax:
Practice Address - Street 1:B16 CALLE MARGINAL
Practice Address - Street 2:URB FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5435
Practice Address - Country:US
Practice Address - Phone:787-529-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical