VIVIAN MEDINA
NPI 1912619909
Counselor in Ewing, NJ

Q: What is Vivian Medina's NPI number?

The NPI number for Vivian Medina is 1912619909. It was assigned to this individual provider in the NPPES registry on December 21, 2022.

Q: What is Vivian Medina's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Vivian Medina was last updated on December 21, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 21, 2022PECOS Enrolled

1014 WHITEHEAD ROAD EXT, EWING, NJ 08638(609) 771-3777 Get Directions Write a Review

NPPES record last updated: December 21, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About Vivian Medina NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VIVIAN MEDINA (NPI 1912619909) is an individual counselor in Ewing, New Jersey and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1912619909

Entity TypeIndividualFemale

Primary Taxonomy101Y00000X

Provider Legal NameVIVIAN MEDINA

Location Address1014 WHITEHEAD ROAD EXTEwing, NJ 08638-2406

Mailing Address1014 Whitehead Road ExtEwing, NJ 08638-2406 · (609) 771-3777

Phone(609) 771-3777

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateDecember 21, 2022

NPPES CertifiedDecember 21, 2022

✔ NPI 1912619909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

1014 WHITEHEAD ROAD EXT, Ewing, NJ 08638

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vivian Medina is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID840770558

PECOS Enrollment IDI20260212002940

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Leave this field empty

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PHOENIX BEHAVIORAL HEALTH LLC

Clinic/Center