Provider Demographics
NPI:1700589256
Name:MEDINA PEREZ, ALONDRA IVELISSE (MSW)
Entity Type:Individual
Prefix:
First Name:ALONDRA
Middle Name:IVELISSE
Last Name:MEDINA PEREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SYLVAN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1310
Mailing Address - Country:US
Mailing Address - Phone:787-452-7351
Mailing Address - Fax:
Practice Address - Street 1:3 SYLVAN PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1310
Practice Address - Country:US
Practice Address - Phone:787-452-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122314-01101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor