Healthcare Provider Details

I. General information

NPI: 1437706439
Provider Name (Legal Business Name): MELISSA GARCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-2766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0249
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: