Provider Demographics
NPI:1316243231
Name:MEDELLIN, LORENA (LCSW)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MEDELLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 591637
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0131
Mailing Address - Country:US
Mailing Address - Phone:210-618-9680
Mailing Address - Fax:
Practice Address - Street 1:302 E JOSEPHINE ST STE 1101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1161
Practice Address - Country:US
Practice Address - Phone:210-618-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical