Individual
LILLIAN S MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
80-20 KEW GARDENS, SUITE 704, KEW GARDENS, NY 11415
(718) 520-1513
(718) 520-6460
Mailing address
15648 77TH ST, HOWARD BEACH, NY 11414-2569
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20290
NY
Other
Enumeration date
07/21/2008
Last updated
07/16/2021
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