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NPI Code Detail

MEDICARE: LISA GARCIA LCSW

MEDICARE: LISA GARCIA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149024127IL

General Provider Information

NPI Number : 1063168417
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA GARCIA LCSW
Provider Business Mailing Address
First Line : 5213 FREDERICK CT
Second Line : APT D
City : GURNEE
State : IL
Zip : 60031
Country : US
Telephone Number : 773-870-0261
Fax Number :
Provider Business Practice Location Address
First Line : 1860 W WINCHESTER RD STE 205
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5317
Country : US
Telephone Number : 223-424-4194
Fax Number : 224-424-4102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2022
Last Update Date : 02/24/2022

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