Healthcare Provider Details

I. General information

NPI: 1235026444
Provider Name (Legal Business Name): GINA ERATO GARZA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ARNOLD ST UNIT 1
PROVIDENCE RI
02906-1001
US

IV. Provider business mailing address

23 WASHBURN AVE
RUMFORD RI
02916-2812
US

V. Phone/Fax

Practice location:
  • Phone: 401-203-4108
  • Fax:
Mailing address:
  • Phone: 414-659-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02416
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: