Basic Information
| Provider Information | |||||||||
| NPI: | 1326299710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA-DEROSE | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ESTHER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BACHELOR OF SCIENCE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | ESTHER | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | BS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15818 SW WARFIELD BLVD | ||||||||
| Address2: | |||||||||
| City: | INDIANTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349563513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725970411 | ||||||||
| FaxNumber: | 7725970412 | ||||||||
| Practice Location | |||||||||
| Address1: | 15818 SW WARFIELD BLVD | ||||||||
| Address2: | |||||||||
| City: | INDIANTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349563513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725970411 | ||||||||
| FaxNumber: | 7725970412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2008 | ||||||||
| LastUpdateDate: | 10/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N/A | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.