Provider Demographics
NPI:1720324338
Name:MALDONADO-TEJEDA, PRISCILLA
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:MALDONADO-TEJEDA
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 1:10722 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1124
Mailing Address - Country:US
Mailing Address - Phone:347-886-8888
Mailing Address - Fax:
Practice Address - Street 1:199 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1907
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:718-488-0128
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker