Provider Demographics
NPI:1871135749
Name:MALDONADO, WALESKA (PHD, MRC)
Entity type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PHD, MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 91 BOX 9178
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9675
Mailing Address - Country:US
Mailing Address - Phone:939-248-3845
Mailing Address - Fax:
Practice Address - Street 1:68 CALLE ESTEBAN PADILLA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6705
Practice Address - Country:US
Practice Address - Phone:939-248-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1363225C00000X
PR6664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty