Healthcare Provider Details

I. General information

NPI: 1225976046
Provider Name (Legal Business Name): DANIELLE GARCIA LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 K-2 BUFFALO TRAIL
PENASCO NM
87553
US

IV. Provider business mailing address

1321 STATE ROAD 75
PENASCO NM
87553-9741
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-0673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0760
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: