Provider Demographics
NPI:1639321664
Name:MEDINA, EMILY R (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:PRESTIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1312
Mailing Address - Country:US
Mailing Address - Phone:203-446-6486
Mailing Address - Fax:
Practice Address - Street 1:50 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1312
Practice Address - Country:US
Practice Address - Phone:203-446-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical