Provider Demographics
NPI:1851141709
Name:MEDINA-MARTINEZ, LEEANN K (LCSW)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:K
Last Name:MEDINA-MARTINEZ
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 1:14 PLUTO LN
Mailing Address - Street 2:
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548-5145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD STE LL1
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2215
Practice Address - Country:US
Practice Address - Phone:516-698-5511
Practice Address - Fax:516-418-5377
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical