| Doctor Name: | MR. IVAN ALDO MEDRANO |
| NPI Number: | 1790188647 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 0931321 |
| Business Practice Address: | 8212 151st Ave Howard Beach, NY - 114141793 |
| Business Phone Number: | 7188480300 |
| Business Fax Number: | 7188352862 |
| Mailing Address: | 8212 151st Ave, HOWARD BEACH |
| State: | NY |
| Postal Code: | 114141793 |
| Phone Number: | 7188480300 |
| Fax Number: | 7188352862 |
| NPI Enumeration Date: | 10/07/2014 |
| NPI Last Update Date: | 10/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251300000X |
| License Number: | 0931321 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Local Education Agency (LEA) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 |