Provider Demographics
NPI:1861797672
Name:MEDINA, EVELYN (MSW)
Entity type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE FELIPE CRUZ
Mailing Address - Street 2:42587
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9307
Mailing Address - Country:US
Mailing Address - Phone:787-644-6594
Mailing Address - Fax:
Practice Address - Street 1:CALLE FELIPE CRUZ
Practice Address - Street 2:42587
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9307
Practice Address - Country:US
Practice Address - Phone:787-644-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical