Provider Demographics
NPI:1477261378
Name:MEDINA, SOLANGE (MSW)
Entity Type:Individual
Prefix:
First Name:SOLANGE
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 1:11 RADCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6131
Mailing Address - Country:US
Mailing Address - Phone:347-294-9978
Mailing Address - Fax:
Practice Address - Street 1:91 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3731
Practice Address - Country:US
Practice Address - Phone:516-868-3030
Practice Address - Fax:516-868-3374
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker