| Organization Name: | EMILY MEDINA, LCSW, LLC |
| NPI Number: | 1114318656 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMILY MEDINA (LCSW) |
| Mailing Address: | 2 Ivy Brook Rd Shelton |
| State: | CT US |
| Postal Code: | 064846416 |
| Phone Number: | 2034466486 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2015 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 007837 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |