Provider Demographics
NPI:1407455835
Name:MEDRANO, AMY S
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BEERY BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2904
Mailing Address - Country:US
Mailing Address - Phone:937-543-6398
Mailing Address - Fax:
Practice Address - Street 1:765 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1960
Practice Address - Country:US
Practice Address - Phone:937-505-1877
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1440365104100000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)