Edwardo J Medina Jr., PHD THD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

SW081981

Practice address

800 Manor Rd #2V
Professional Suites #2V
Staten Island, NY 10314-7016

Phone

(646) 266-4010

Fax

(718) 761-5562

NPI assigned

May 1, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Universal Life Church Inc

  dba Kabbalah Nation Kingdom Canal Zone Usauk Scientist Inc

  • Religious Nonmedical Health Care Institution
  • Staten Island, NY
  • NPI 1780805721
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1437370137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 0891",
            "address_2": "KABBELAH SW NY NJ GROUP",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103140891",
            "telephone_number": "718-720-0292",
            "fax_number": "718-761-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MANOR RD #2V",
            "address_2": "PROFESSIONAL SUITES #2V",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103147016",
            "telephone_number": "646-266-4010",
            "fax_number": "718-761-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "EDWARDO",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PHD THD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "SW081981",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "SW081981",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": "SW081981",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Office PC
• Medical Practice Associates PLLC
• Medical Services of Staten Island PLLC
• Medicine Check PC
• Joselito N Medida, PT
• Genevieve Medina
• Manuel Medina, MD
• Yelizaveta Medina, MD
• Mediquip Products Corp.
• Medix Labs Inc

• Mental Health Counselor in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.