Medina, Edwardo J

Medina, Edwardo J is an individual health care provider with primary practice located at 800 Manor Rd #2V Professional Suites #2V, Staten Island NY 10314-7016. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Medina, Edwardo J can be contacted via phone (646) 266-4010.

Contact Information

Primary practice address
800 Manor Rd #2V Professional Suites #2V Staten Island NY 10314-7016
Phone: (646) 266-4010
Fax: (718) 761-5562
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X SW081981
Behavioral Health & Social Service Providers / Clinical 1041C0700X SW081981
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X SW081981

Profile Details

NPI number 1437370137
LBN Legal business name Medina, Edwardo J
Credentials PHD THD
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2007
Last updated Jul 8th, 2007 - about 19 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.

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