Healthcare Provider Details

I. General information

NPI: 1790290880
Provider Name (Legal Business Name): MARIBEL GARCIA, PSYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PINE AVE STE 440
LONG BEACH CA
90802-4465
US

IV. Provider business mailing address

115 PINE AVE STE 440
LONG BEACH CA
90802-4465
US

V. Phone/Fax

Practice location:
  • Phone: 562-248-9409
  • Fax:
Mailing address:
  • Phone: 562-248-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIBEL GARCIA
Title or Position: OWNER
Credential: PSYD
Phone: 562-248-9409