Provider Demographics
NPI:1962731521
Name:MEDINA-MINTON, NATALIE (DSW, LCSW, BC-TMH)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:MEDINA-MINTON
Suffix:
Gender:F
Credentials:DSW, LCSW, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BROADWAY FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3400
Mailing Address - Country:US
Mailing Address - Phone:929-244-9727
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3400
Practice Address - Country:US
Practice Address - Phone:929-244-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0816521041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical