Provider Demographics
NPI:1578684320
Name:MALDONADO, MADELINE (LCSW-R, LCSW, LSCSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LCSW-R, LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MIDLAND AVENUE
Mailing Address - Street 2:APT 10G
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6428
Mailing Address - Country:US
Mailing Address - Phone:917-880-8193
Mailing Address - Fax:914-346-5031
Practice Address - Street 1:1160 MIDLAND AVENUE
Practice Address - Street 2:APT 10G
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6428
Practice Address - Country:US
Practice Address - Phone:917-880-8193
Practice Address - Fax:914-346-5031
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39371041C0700X
MO20100014911041C0700X
NYP062204-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP12001881OtherMULTIPLAN PROVIDER #
NY269918OtherMHN INSURANCE PROVIDER #
NYP2883938OtherOXFORD PLAN PROVIDER #
NYP2883938OtherOXFORD PLAN PROVIDER #