Healthcare Provider Details

I. General information

NPI: 1134491384
Provider Name (Legal Business Name): DEANNA MEDINA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST ST
DANBURY CT
06810-6528
US

IV. Provider business mailing address

75 WEST ST
DANBURY CT
06810-6528
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-5689
  • Fax: 203-205-2757
Mailing address:
  • Phone: 203-748-5689
  • Fax: 203-205-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: