MEDICARE: MS. SANJA MEDICH MA, LMHC

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
1	101YM0800X	Mental Health Counselor	003224	NY

General Provider Information

NPI Number	:	1538238910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANJA MEDICH MA, LMHC

Provider Business Mailing Address
First Line	:	623 W 170TH ST APT 3D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3213
Country	:	US
Telephone Number	:	646-283-5463
Fax Number	:	212-927-1781

Provider Business Practice Location Address
First Line	:	613 W 169TH ST APT 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-2914
Country	:	US
Telephone Number	:	646-283-5463
Fax Number	:	212-927-1781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/20/2018

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