Provider Demographics
NPI:1750012845
Name:MEDINA, EVELYN (LCSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7742 N KENDALL DR STE 275
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7523
Mailing Address - Country:US
Mailing Address - Phone:786-306-8778
Mailing Address - Fax:888-318-4788
Practice Address - Street 1:7000 SW 62ND AVE STE PH-S
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:561-444-3512
Practice Address - Fax:888-318-4788
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical