Individual
LILLIE MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
804 SARAH ST STE 305, STROUDSBURG, PA 18360-1739
(570) 422-6522
(570) 422-6524
Mailing address
804 SARAH ST STE 305, STROUDSBURG, PA 18360-1739
(570) 422-6522
(570) 422-6524
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18746
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
457047
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18746
CASAC,BHS,PROGRAM DIRECTOR,CLINICAL
NY
01
—
457047
DDAP
PA
Enumeration date
06/16/2016
Last updated
06/16/2016
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