Individual provider Active NPI

Olivia S Maldonado, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • New York, NY
National Provider Identifier
1366813651
Registry record updated Oct 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
021242 Issued in NY
Practice address
515 W 182ND St
Medical Room 101
New York, NY 10033-5107
Phone
(646) 317-0234
NPI assigned
Oct 12, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 021242 NY Primary

Addresses

Primary practice location

515 W 182ND St
Medical Room 101
New York, NY 10033-5107

Mailing address

515 W 182ND St
Medical Room 101
New York, NY 10033-5107
Phone (646) 317-0234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160304000090 NY Order and Referring Only - Clinical Psychologist 6800192626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444608000000",
    "number": "1366813651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 W 182ND ST",
            "address_2": "MEDICAL ROOM 101",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100335107",
            "telephone_number": "646-317-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 W 182ND ST",
            "address_2": "MEDICAL ROOM 101",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100335107",
            "telephone_number": "646-317-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "OLIVIA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2015-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "021242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.