Provider Demographics
NPI:1629392048
Name:MALDONADO, WANDA MARGARITA (MS, LMHC)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:MARGARITA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 ALCALDE CT UNIT 110
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3065
Mailing Address - Country:US
Mailing Address - Phone:407-301-8185
Mailing Address - Fax:
Practice Address - Street 1:6450 ALCALDE CT UNIT 110
Practice Address - Street 2:SUITE 16
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3065
Practice Address - Country:US
Practice Address - Phone:407-301-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12067101YM0800X
PR1260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist