Provider Demographics
NPI:1750012845
Name:MEDINA, EVELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18495 S DIXIE HWY STE 318
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6817
Mailing Address - Country:US
Mailing Address - Phone:786-258-8499
Mailing Address - Fax:888-318-4788
Practice Address - Street 1:7000 SW 62ND AVE STE PH-S
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:561-444-3512
Practice Address - Fax:888-318-4788
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical