Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1342 | SC |
Y | 103TC0700X | Clinical Psychologist | 1342 | SC |
NPI | 1003205253 |
---|---|
Provider Name | Julie Mcelrath Maldonado |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-3580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PS0569 | (05) | SC |