Individual
ELISABETH MARY MEDINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
38 CHESTNUT AVE, POMPTON LAKES, NJ 07442-2406
(973) 907-4908
Mailing address
38 CHESTNUT AVE, POMPTON LAKES, NJ 07442-2406
(973) 907-4908
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
44SL06073800
NJ
1041C0700X
Clinical Social Worker
Primary
44SC05963500
NJ
Other
Enumeration date
03/06/2018
Last updated
02/18/2021
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