MEDICARE: MARCELA MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW15365	FL
2	1041C0700X	Clinical Social Worker	24606	MD
3	1041C0700X	Clinical Social Worker
4	1041C0700X	Clinical Social Worker	50081938	DC
5	1041S0200X	School Social Worker	50081938	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942676937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA MEDINA

Provider Business Mailing Address
First Line	:	4835 SW 111TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6132
Country	:	US
Telephone Number	:	786-624-9329
Fax Number	:

Provider Business Practice Location Address
First Line	:	4835 SW 111TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6132
Country	:	US
Telephone Number	:	786-301-8476
Fax Number	:	786-301-8476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	02/17/2025

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Directions to “ MARCELA MEDINA ” Practice Location

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