Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marisa Denise Medina, LCSW127143

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1770757445

Marisa Denise Medina, LCSW127143 is a Clinical Social Worker in Fontana, California. Qualified in 2018, 8 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2008
Specialties on file
2
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Practice location Address checks out

17343 Anastasia Ave
Fontana, CA 92335-4933
Phone: (626) 201-6674
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW127143 (CA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X

Record details

NPI number1770757445
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW127143
Sole proprietorYes
NPI enumeratedApril 14, 2008
Last updated in NPPESJanuary 16, 2025
Certification dateJanuary 16, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Fontana