| Doctor Name: | MILLIE MEDINA |
| NPI Number: | 1043511652 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | |
| Business Practice Address: | 344 Fulton Ave Hempstead, NY - 11550 |
| Business Phone Number: | 5165382613 |
| Business Fax Number: | |
| Mailing Address: | 49 Yale St, INWOOD |
| State: | NY |
| Postal Code: | 110961024 |
| Phone Number: | 5168127988 |
| Fax Number: | |
| NPI Enumeration Date: | 11/12/2010 |
| NPI Last Update Date: | 02/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |