Healthcare Provider Details

I. General information

NPI: 1205993375
Provider Name (Legal Business Name): EMILY GILL GARNICA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMY GILL GARNICA LCSW

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 SAN ELIJO AVE # J SUITE J
CARDIFF BY THE SEA CA
92007-1726
US

IV. Provider business mailing address

2047 SAN ELIJO AVE # J SUITE J
CARDIFF BY THE SEA CA
92007-1726
US

V. Phone/Fax

Practice location:
  • Phone: 760-943-0319
  • Fax:
Mailing address:
  • Phone: 760-943-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS7068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: