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General NPI Number Information
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NPI Number | 1477983484
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Entity Type | Individual
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Provider Name | JO MEDINA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 120 CENTER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-1062
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Country | US
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Telephone | 516-520-8370
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Fax | 516-520-6288
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Provider Business Mailing Address
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Address Line | 120 CENTER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-1062
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Country | US
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Telephone | 516-520-8370
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Fax | 516-520-6288
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 033491
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 033491
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License Number State | NY
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