Provider Demographics
NPI:1245704071
Name:MEDINA, JOSHUA MATTHEW (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MATTHEW
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 E PACIFIC COAST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4806
Mailing Address - Country:US
Mailing Address - Phone:949-391-3439
Mailing Address - Fax:
Practice Address - Street 1:6272 E PACIFIC COAST HWY STE D
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4806
Practice Address - Country:US
Practice Address - Phone:949-391-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA841801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical