Individual
LEASA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 471-5006
Mailing address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-10726
NM
Other
Enumeration date
08/31/2016
Last updated
07/22/2020
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