Provider Demographics
NPI:1437978442
Name:MEDINA, REBECCA SAVINA (ASW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SAVINA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SAVINA
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2241 W BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3934
Mailing Address - Country:US
Mailing Address - Phone:559-602-8812
Mailing Address - Fax:
Practice Address - Street 1:530 KINGS COUNTY DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3579
Practice Address - Country:US
Practice Address - Phone:559-754-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW126212104100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker