Provider Demographics
NPI:1225564313
Name:MEDINA, NEISHMA (PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:NEISHMA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CALLE EMETERIO HERNANDEZ
Mailing Address - Street 2:PASEO DE LOS ARTESANOS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9671
Mailing Address - Country:US
Mailing Address - Phone:939-639-0388
Mailing Address - Fax:
Practice Address - Street 1:206 CALLE EMETERIO HERNANDEZ
Practice Address - Street 2:PASEO DE LOS ARTESANOS
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9671
Practice Address - Country:US
Practice Address - Phone:939-639-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5492405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5492OtherLICENCIA