Provider Demographics
NPI:1841825874
Name:MALDONADO RIVERA, JOSHUA EMANUELLE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EMANUELLE
Last Name:MALDONADO RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1704
Mailing Address - Country:US
Mailing Address - Phone:787-633-0740
Mailing Address - Fax:
Practice Address - Street 1:2052 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-4746
Practice Address - Country:US
Practice Address - Phone:513-863-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health