Provider Demographics
NPI:1578061412
Name:DRA CARMEN L MALDONADO TRINIDAD
Entity Type:Organization
Organization Name:DRA CARMEN L MALDONADO TRINIDAD
Other - Org Name:SERVICIOS PSICOLOGICOS DRA CARMEN L MALDONADO TRINIDAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALDONADO TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:BAED; MAED; MAR;PSYD
Authorized Official - Phone:787-529-6055
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:787-369-7632
Practice Address - Street 1:B16 STE 2 CALLE MARGINAL
Practice Address - Street 2:URB FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-529-6055
Practice Address - Fax:787-369-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty