Provider Demographics
NPI:1033237441
Name:MEDINA, SAUL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAUL
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3043
Mailing Address - Country:US
Mailing Address - Phone:805-240-0869
Mailing Address - Fax:
Practice Address - Street 1:725 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2748
Practice Address - Country:US
Practice Address - Phone:805-933-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW196841041C0700X
CALCSW833081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical