Healthcare Provider Details

I. General information

NPI: 1891340972
Provider Name (Legal Business Name): MARIA E MEDINA-MACIAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-01 BROADWAY
FAIR LAWN NJ
07410-2026
US

IV. Provider business mailing address

371 CLIFTON BLVD
CLIFTON NJ
07013-1806
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: