Healthcare Provider Details

I. General information

NPI: 1083300206
Provider Name (Legal Business Name): GLADYBEL GARCIA SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB STA JUANITA EN 41 CALLE BOABAL
BAYAMON PR
00956
US

IV. Provider business mailing address

URB STA JUANITA EN 41 CALLE BOABAL
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-922-7101
  • Fax:
Mailing address:
  • Phone: 787-922-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16565
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: