Provider Demographics
NPI:1598437808
Name:CECUNJANIN, MEDINA
Entity Type:Individual
Prefix:
First Name:MEDINA
Middle Name:
Last Name:CECUNJANIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E BROADWAY # 61B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6110
Mailing Address - Country:US
Mailing Address - Phone:203-515-7227
Mailing Address - Fax:
Practice Address - Street 1:61 E BROADWAY # 61B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6110
Practice Address - Country:US
Practice Address - Phone:203-515-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical