| Doctor Name: | MR. ROBERT MEDINA |
| NPI Number: | 1013149632 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC |
| License Number: | MH9670 |
| Business Practice Address: | 10400 Sw Stephanie Way Apt 207 Port Saint Lucie, FL - 349871971 |
| Business Phone Number: | 8134165458 |
| Business Fax Number: | |
| Mailing Address: | 10400 Sw Stephanie Way, Apt 207 PORT SAINT LUCIE |
| State: | FL |
| Postal Code: | 349871971 |
| Phone Number: | 8134165458 |
| Fax Number: | |
| NPI Enumeration Date: | 08/14/2009 |
| NPI Last Update Date: | 08/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH9670 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |