Basic Information
| Provider Information | |||||||||
| NPI: | 1003954835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 SHIELDS ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018456279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018418896 | ||||||||
| FaxNumber: | 4018484192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW000014 | RI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.