Basic Information
| Provider Information | |||||||||
| NPI: | 1982615621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | FOSTER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 SOUTH KINGMAN ROAD | ||||||||
| Address2: | |||||||||
| City: | SOUTH ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957047 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC00012200 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | VA HEALLTH CARE | 01 | VA HEALTH CARE | OTHER |