Provider Demographics
NPI:1255020558
Name:MADERA, WILMARY
Entity type:Individual
Prefix:
First Name:WILMARY
Middle Name:
Last Name:MADERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROOSVELT GDNS
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3400
Mailing Address - Country:US
Mailing Address - Phone:787-934-7503
Mailing Address - Fax:
Practice Address - Street 1:14 ROOSVELT GDNS
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-3400
Practice Address - Country:US
Practice Address - Phone:787-934-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker