MEDICARE: ANA O GARCIA CRC, CASAC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1760888606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA O GARCIA CRC, CASAC

Provider Business Mailing Address
First Line	:	415 CLAREMONT PKWY APT 3D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8053
Country	:	US
Telephone Number	:	347-485-2463
Fax Number	:	718-387-3015

Provider Business Practice Location Address
First Line	:	728 DRIGGS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4343
Country	:	US
Telephone Number	:	718-782-6802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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