Provider Demographics
NPI:1457244329
Name:MEDINA, ANDREW MARLON (LPC-A)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARLON
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BRANFORD RD UNIT 329
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1372
Mailing Address - Country:US
Mailing Address - Phone:718-902-5299
Mailing Address - Fax:
Practice Address - Street 1:100 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5010
Practice Address - Country:US
Practice Address - Phone:203-299-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.007646-ASOC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional