Basic Information
| Provider Information | |||||||||
| NPI: | 1790310662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010404704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138460445 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 80 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010404704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138460445 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2020 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 71756 | 01 | MA | TUFTS | OTHER | 1134107113 | 01 | MA | BEACON | OTHER | 1134107113 | 01 | MA | FALLON | OTHER | 1134107113 | 01 | MA | NHP | OTHER | 12529 | 01 | MA | HNE | OTHER | 042622756 | 01 | MA | CCA | OTHER | 1134107113 | 01 | MA | MBHP | OTHER | 997303 | 01 | MA | NETWORK HEALTH | OTHER | 1134107113 | 05 | MA | MEDICAID | Y10086 | 01 | MA | MEDICARE | OTHER |