Mary Elizabeth Medina, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R032084 Issued in NY

Practice address

1136 Castle Hill Ave
Bronx, NY 10462-4801

Phone

(718) 239-0395

NPI assigned

Sep 10, 2019

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)

Enrolled

State licenses

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1073162145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 E 96TH ST APT 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101283847",
            "telephone_number": "646-331-9025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 CASTLE HILL AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104624801",
            "telephone_number": "718-239-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R032084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Carlos Medina
• Kirsis Medina, LPN
• Lourdes Medina, TEACHER
• Lynzee Medina
• Marangely Medina
• Michael Medina
• Michael Medina, PA-C
• Miguel Angel Medina, LCSW
• Mimi Medina, L.M.S.W.
• Nicholas Medina

• Clinical Social Worker in Bronx, NY
• Providers in Bronx, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.