Healthcare Provider Details

I. General information

NPI: 1851305494
Provider Name (Legal Business Name): GLORIA MARIA GARCIA LCSW, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 22ND AVE
MIAMI FL
33142-8429
US

IV. Provider business mailing address

2333 SW 34TH AVE
MIAMI FL
33145-3144
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-3000
  • Fax: 305-638-6856
Mailing address:
  • Phone: 305-443-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: