Active NPI
Vanessa Medina, LCSW
- Clinical Social Worker
- Round Rock, TX
National Provider Identifier
1205120037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 50169
- Practice address
- 2120 N Mays St
Suite 490
Round Rock, TX 78664-2192 - Phone
- (512) 341-8908
- Fax
- (512) 255-8521
- NPI assigned
- Jun 9, 2011
- Last updated
- Jun 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 50169 | TX | Primary |
Addresses
Primary practice location
2120 N Mays St
Suite 490
Round Rock, TX 78664-2192
Mailing address
17409 Wiseman Dr
Pflugerville, TX 78660-5723
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50169 | TX | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lone Star Circle of Care | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lone Star Circle of Care at Georgetown Dental
- Federally Qualified Health Center (FQHC)
- Georgetown, TX
- NPI 1639129331
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307577600000",
"number": "1205120037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17409 WISEMAN DR",
"city": "PFLUGERVILLE",
"state": "TX",
"postal_code": "786605723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 N MAYS ST",
"address_2": "SUITE 490",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "786642192",
"telephone_number": "512-341-8908",
"fax_number": "512-255-8521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "VANESSA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-09",
"last_updated": "2011-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "50169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.