Provider Demographics
NPI:1699446617
Name:MEDINA-CLAUDIO, BRENDA N (MSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:N
Last Name:MEDINA-CLAUDIO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 W SHERWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2638
Mailing Address - Country:US
Mailing Address - Phone:213-375-1957
Mailing Address - Fax:
Practice Address - Street 1:1823 W SHERWAY ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2638
Practice Address - Country:US
Practice Address - Phone:213-375-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical