Active NPI
Sheila Medina, LSW
- Social Worker
- Pompton Lakes, NJ
National Provider Identifier
1912774969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 44SL07045200
- Practice address
- 123 Wanaque Ave
Pompton Lakes, NJ 07442-2101 - Phone
- (862) 420-3100
- NPI assigned
- Dec 11, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL07045200 | NJ | Primary |
Addresses
Primary practice location
123 Wanaque Ave
Pompton Lakes, NJ 07442-2101
Mailing address
100 Cloverdale Rd FL 2
Clifton, NJ 07013-1908
Phone (551) 296-8197
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL07045200 | NJ | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702252800000",
"number": "1912774969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 CLOVERDALE RD FL 2",
"city": "CLIFTON",
"state": "NJ",
"postal_code": "070131908",
"telephone_number": "551-296-8197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 WANAQUE AVE",
"city": "POMPTON LAKES",
"state": "NJ",
"postal_code": "074422101",
"telephone_number": "862-420-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "SHEILA",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-11",
"last_updated": "2023-12-11",
"certification_date": "2023-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SL07045200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pompton Lakes, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.