Individual
BETH C VANKEUREN MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 732-7474
(203) 735-1550
Mailing address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 732-7474
(203) 735-1550
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005811
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004039244
—
CT
01
—
318983
MHN PROVIDER NUMBER
CT
Enumeration date
07/21/2006
Last updated
01/31/2013
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