Provider Demographics
NPI:1255174850
Name:MALDONADO, TAILYNN (LMSW-T)
Entity type:Individual
Prefix:
First Name:TAILYNN
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:U
Credentials:LMSW-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1324
Mailing Address - Country:US
Mailing Address - Phone:623-695-7980
Mailing Address - Fax:602-691-0233
Practice Address - Street 1:333 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1324
Practice Address - Country:US
Practice Address - Phone:623-695-7980
Practice Address - Fax:602-691-0233
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-08168T104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker