Healthcare Provider Details

I. General information

NPI: 1821381302
Provider Name (Legal Business Name): JACQUELINE MARIE GARCIA M.S. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E END AVE CLARKE SCHOOL
NEW YORK NY
10028-8004
US

IV. Provider business mailing address

80 E END AVE CLARKE SCHOOL
NEW YORK NY
10028-8004
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-3500
  • Fax: 212-585-3300
Mailing address:
  • Phone: 212-585-3500
  • Fax: 212-585-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number1130098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: