Healthcare Provider Details

I. General information

NPI: 1831862952
Provider Name (Legal Business Name): CHANELLE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HARTWELL AVE
LEXINGTON MA
02421-3100
US

IV. Provider business mailing address

75 SYLVAN ST BLDG C
DANVERS MA
01923-2763
US

V. Phone/Fax

Practice location:
  • Phone: 781-861-0890
  • Fax:
Mailing address:
  • Phone: 978-619-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: