Licelott Marie Maldonado, CLIN. PSYCHOLOGIST

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5821 Issued in PR

Practice address

450 Calle Ferrocarril Ste 203
Ponce, PR 00717-4105

Phone

(787) 638-3778

NPI assigned

Mar 10, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1801471024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8930",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007328930",
            "telephone_number": "787-638-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CALLE FERROCARRIL STE 203",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007174105",
            "telephone_number": "787-638-3778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Calle Betances",
            "address_purpose": "LOCATION",
            "city": "Yauco",
            "state": "PR",
            "postal_code": "006983647",
            "country_code": "US",
            "telephone_number": "787-638-3778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "LICELOTT",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "CLIN. PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "5821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felix Maldonado, M.D.
• Giselle Marie Maldonado, LIC. OPTICO
• Gretchen Lorraine Maldonado
• Karla Michelle Maldonado
• Lady Judith Maldonado, M.A.
• Nahil Maldonado, MD
• Natalie Maldonado
• Viveca Maldonado, OD
• Zilkia Enid Maldonado
• Natalia Maria Manes Rubio

• Clinical Psychologist in Ponce, PR
• Providers in Ponce, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.