Provider Demographics
NPI:1023768819
Name:MALDONADO RIVERA, GRETCHEN NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:NICOLE
Last Name:MALDONADO RIVERA
Suffix:
Gender:F
Credentials:PSYD
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 143862
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3862
Mailing Address - Country:US
Mailing Address - Phone:787-320-6327
Mailing Address - Fax:
Practice Address - Street 1:CARR. 635 KM 2.4 BO. DOMINGUITO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-320-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical