Healthcare Provider Details

I. General information

NPI: 1861084139
Provider Name (Legal Business Name): MICHAEL GARDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE GARDA

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 FULLERTON AVE
NEWBURGH NY
12550-3768
US

IV. Provider business mailing address

1 VANAMEE ST
NEWBURGH NY
12550-4049
US

V. Phone/Fax

Practice location:
  • Phone: 845-275-3778
  • Fax:
Mailing address:
  • Phone: 732-824-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: