Jacquelyne Cisneros Medina, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

68577 Issued in TX

Practice address

1551 Montana Ave
El Paso, TX 79902-5668

Phone

(915) 757-7999

NPI assigned

Dec 20, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacquelyne Olivia Cisneros Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• El Paso Community MHMR

  • Multi-Specialty Clinic/Center
  • El Paso, TX
  • NPI 1649345869
  Medicare reassignment NPD
• El Paso Community MHMR

  • Substance Use Disorder Rehabilitation Clinic/Center
  • El Paso, TX
  • NPI 1770009334
  NPD

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

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1831661479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7417 LE CONTE DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799127129",
            "telephone_number": "915-887-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 MONTANA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799025668",
            "telephone_number": "915-757-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JACQUELYNE",
        "middle_name": "CISNEROS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "68577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYNE",
            "last_name": "CISNEROS",
            "middle_name": "OLIVIA",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Desiree Medina, FNP
• Eliael Medina, MD
• Elizabeth Medina, MD
• Gabriela Medina
• Jacqueline Medina, PHARMD
• Jocelyn Medina, PMHNP
• Jorge Arturo Medina Jr., FPMHNP-BC, MSN, RN
• Jose Medina
• Lucia Medina, ANP
• Pedro Steve Medina

• Clinical Social Worker in El Paso, TX
• Providers in El Paso, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.