Provider Demographics
NPI:1033703533
Name:MALDONADO, ADAM L (MS, LCPC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 LORLYN CIR APT 1E
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1732
Mailing Address - Country:US
Mailing Address - Phone:815-757-7966
Mailing Address - Fax:
Practice Address - Street 1:106 S LINCOLNWAY STE F
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1597
Practice Address - Country:US
Practice Address - Phone:815-757-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health