Provider Demographics
NPI:1447522958
Name:MEDINA, JESSICA ANGELA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANGELA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANGELA
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4975 VIA VENTOSA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4639
Mailing Address - Country:US
Mailing Address - Phone:714-618-2521
Mailing Address - Fax:
Practice Address - Street 1:4975 VIA VENTOSA
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4639
Practice Address - Country:US
Practice Address - Phone:714-618-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW32091101YM0800X
CA72501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health