Most Relevant Information
Provider Data
| NPI Number: | 1003552522 |
| Provider Name: | JACQUELINE MEDINA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/08/2022 |
| Last Updated: | 05/08/2022 |
Provider Practice Location
160 W 86TH ST
NEW YORK
NY
100244018
Practice Location Phone/Fax
| Phone: | 2128751300 |
| Fax: |
Provider Mailing Location
5272 72ND ST FL 1
MASPETH
NY
113781436
Provider Mailing Phone/Fax
| Phone: | 3472955181 |
| Fax: |