NPIMap

Individual provider Active NPI

Glenda Enet Medina

  • Counselor
  • Lawrence, MA
National Provider Identifier
1114233103
Registry record updated Aug 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
S888810708 Issued in MA
Practice address
15 Union St Ste 557
Lawrence, MA 01840-1866
Phone
(978) 651-2544
Fax
(978) 686-2954
NPI assigned
Aug 27, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X S888810708 MA Primary

Addresses

Primary practice location

15 Union St Ste 557
Lawrence, MA 01840-1866

Mailing address

15 Union St Suite 557
Lawrence, MA 01840
Phone (978) 651-2544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
S888810708MAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Friend and Family Services Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1114233103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 UNION ST SUITE 557",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "01840",
            "telephone_number": "978-651-2544",
            "fax_number": "978-686-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 UNION ST STE 557",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018401866",
            "telephone_number": "978-651-2544",
            "fax_number": "978-686-2954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "GLENDA",
        "middle_name": "ENET",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-27",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MA",
            "license": "S888810708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.