Marisa Denise Medina, LCSW127143

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW127143 Issued in CA

Practice address

17343 Anastasia Ave
Fontana, CA 92335-4933

Phone

(626) 201-6674

NPI assigned

Apr 14, 2008

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marisa.medina.1@28621.direct.athenahealth.com

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.

• Optum Behavioral Care of California, P.C.

  • Clinical Psychologist
  • Rancho Cucamonga, CA
  • NPI 1417718297
  NPD
• Optum Behavioral Care of California, P.C.

  • Clinical Social Worker
  • Costa Mesa, CA
  • NPI 1447137740
  NPD

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1770757445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12813 PHILADELPHIA ST",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906014118",
            "telephone_number": "562-693-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17343 ANASTASIA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923354933",
            "telephone_number": "626-201-6674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MARISA",
        "middle_name": "DENISE",
        "credential": "LCSW127143",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-14",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW127143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Mecate
• Med Line Transportation Inc
• Erica Chia-CHI Medina, MD
• Graciela Rebeca Medina II
• Marilou Panganiban Medina, D.M.D.
• Valerie J Medina, PA
• Matthew James Meeker, CRNA
• Jagdeep Kaur Mehrok, M.D
• Neel Mehta, PHARM D
• Yogish Mehta, D.D.S

• Clinical Social Worker in Fontana, CA
• Providers in Fontana, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.