Provider Demographics
NPI:1639460090
Name:WALENESKY MEDINA, MARIA ELIZA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELIZA
Last Name:WALENESKY 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 1:423 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5527
Mailing Address - Country:US
Mailing Address - Phone:607-206-7426
Mailing Address - Fax:
Practice Address - Street 1:423 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5527
Practice Address - Country:US
Practice Address - Phone:607-206-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker