Provider Demographics
NPI:1003390964
Name:MEDINA, DINNETTE ARACELY (MA)
Entity Type:Individual
Prefix:
First Name:DINNETTE
Middle Name:ARACELY
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 RHONDA LN
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7457
Mailing Address - Country:US
Mailing Address - Phone:484-554-4615
Mailing Address - Fax:
Practice Address - Street 1:826 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1174
Practice Address - Country:US
Practice Address - Phone:610-419-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty