Provider Demographics
NPI:1134403470
Name:MALDONADO, TEISHA LYNNE (LMSW)
Entity type:Individual
Prefix:MS
First Name:TEISHA
Middle Name:LYNNE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7402
Mailing Address - Country:US
Mailing Address - Phone:585-288-3130
Mailing Address - Fax:585-654-1066
Practice Address - Street 1:1801 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7402
Practice Address - Country:US
Practice Address - Phone:585-288-3130
Practice Address - Fax:585-654-1066
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065842-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool