Healthcare Provider Details

I. General information

NPI: 1003749193
Provider Name (Legal Business Name): MIREYA MEDINA FERREIRA LCSW, MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 NW DOWNS ST
PORT ST LUCIE FL
34986-4006
US

IV. Provider business mailing address

5525 NW DOWNS ST
PORT ST LUCIE FL
34986-4006
US

V. Phone/Fax

Practice location:
  • Phone: 561-408-5220
  • Fax:
Mailing address:
  • Phone: 561-408-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21483
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP.0101221
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017411
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: