Elisabeth Mary Medino, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05963500 Issued in NJ

Practice address

38 Chestnut Ave
Pompton Lakes, NJ 07442-2406

Phone

(973) 907-4908

NPI assigned

Mar 6, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1396247342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 CHESTNUT AVE",
            "city": "POMPTON LAKES",
            "state": "NJ",
            "postal_code": "074422406",
            "telephone_number": "973-907-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 CHESTNUT AVE",
            "city": "POMPTON LAKES",
            "state": "NJ",
            "postal_code": "074422406",
            "telephone_number": "973-907-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINO",
        "first_name": "ELISABETH",
        "middle_name": "MARY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-06",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SL06073800",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05963500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Beth McDonald, LPC, LCADC, ACS
• Kenneth McGill, LMFT
• Medical Associates of North Jersey,P.a.
• Medicus Medical Transportation Inc
• Sheila Medina, LSW
• Melinda Lee Miller
• Maria Elena Misito, LCSW
• Brian Moeltner
• Dora Molina
• Nicholas C Mondello

• Clinical Social Worker in Pompton Lakes, NJ
• Providers in Pompton Lakes, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.