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NPI Code Detail

MEDICARE: VANESSA C MEDINA LCSW

MEDICARE: VANESSA C MEDINA LCSW
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
11041S0200XSchool Social WorkerSWB-2025-0752NM
21041C0700XClinical Social WorkerSWB-2025-0752NM

General Provider Information

NPI Number : 1013621457
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA C MEDINA LCSW
Provider Business Mailing Address
First Line : PO BOX 45281
Second Line :
City : RIO RANCHO
State : NM
Zip : 87174-5281
Country : US
Telephone Number : 505-677-0988
Fax Number : 505-808-4942
Provider Business Practice Location Address
First Line : 500 LASER RD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-4517
Country : US
Telephone Number : 505-962-1242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2023
Last Update Date : 06/02/2026

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Directions to “ VANESSA C MEDINA LCSW” Practice Location

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