Provider Demographics
NPI:1770808768
Name:MALDONADO, JOCELYN ENID (MA)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:ENID
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JOCELYN
Other - Middle Name:ENID
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:URB. ESTANCIAS DEL MAYORAL 12109
Mailing Address - Street 2:CALLE TRAPICHE A-14
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-457-5045
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE RECUPERACION DEL CARIBE
Practice Address - Street 2:BO. JAGUEYES, CARR.149, KM 58.1 SUITE G-2
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-955-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1795103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1795OtherPSYCHOLOGY