Provider Demographics
NPI:1538238910
Name:MEDICH, SANJA (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:SANJA
Middle Name:
Last Name:MEDICH
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:SANJA
Other - Middle Name:
Other - Last Name:MEDICH-LJUBICIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:623 W 170TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3213
Mailing Address - Country:US
Mailing Address - Phone:646-283-5463
Mailing Address - Fax:212-927-1781
Practice Address - Street 1:613 W 169TH ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2914
Practice Address - Country:US
Practice Address - Phone:646-283-5463
Practice Address - Fax:212-927-1781
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health