Individual
BRENDA MEDINA
Active
Individual
BRENDA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
C-10485
NM
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03300595
—
NM
Enumeration date
06/25/2015
Last updated
10/02/2018
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