Basic Information
Provider Information
NPI: 1811576721
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARCIA
FirstName: BEGONIA-ZEKE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GARCIA
OtherFirstName: GABRIELLA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 55 DODGE RD
Address2:  
City: GETZVILLE
State: NY
PostalCode: 140681205
CountryCode: US
TelephoneNumber: 7168312700
FaxNumber:  
Practice Location
Address1: 37 NIAGARA ST
Address2:  
City: TONAWANDA
State: NY
PostalCode: 141501105
CountryCode: US
TelephoneNumber: 7168311850
FaxNumber: 7168346785
Other Information
ProviderEnumerationDate: 04/07/2021
LastUpdateDate: 09/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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