Provider Demographics
NPI:1760854814
Name:MEDINA, MAGDALENA ELIZABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:ELIZABETH
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEW DORP PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1219
Mailing Address - Country:US
Mailing Address - Phone:516-410-9953
Mailing Address - Fax:
Practice Address - Street 1:368 VETERANS MEMORIAL HWY STE 3
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4322
Practice Address - Country:US
Practice Address - Phone:631-533-0315
Practice Address - Fax:855-752-5170
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty