Provider Demographics
NPI:1972976595
Name:MEDINA-WOLF, LUNA LEVANA (LMHC, NCC, MCAP)
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:LEVANA
Last Name:MEDINA-WOLF
Suffix:
Gender:F
Credentials:LMHC, NCC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22553 SWORDFISH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4614
Mailing Address - Country:US
Mailing Address - Phone:561-571-1557
Mailing Address - Fax:561-634-3537
Practice Address - Street 1:6919 SW 18TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7010
Practice Address - Country:US
Practice Address - Phone:561-571-1557
Practice Address - Fax:561-634-3537
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health