Medina, Brenda
Medina, Brenda is an individual health care provider with primary practice located at 428 Los Lentes Rd Se Ste 3 , Los Lunas NM 87031-6018. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Medina, Brenda can be contacted via phone (505) 865-3350.Contact Information
Primary practice address
428 Los Lentes Rd Se Ste 3
Los Lunas NM 87031-6018
Phone: (505) 865-3350
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | ||
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C-10485 | New Mexico |
Profile Details
| NPI number | 1023490034 |
|---|---|
| LBN Legal business name | Medina, Brenda |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 25th, 2015 |
| Last updated | Oct 2nd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023490034 | NPPES |
| New Mexico | MEDICAID | 03300595 |
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