MEDICARE: MRS. TERRY ANN GARCIA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSC22750	CA
2	1041C0700X	Clinical Social Worker	LCS22750	CA

General Provider Information

NPI Number	:	1124058540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERRY ANN GARCIA LCSW

Provider Business Mailing Address
First Line	:	12627 SANTA GERTRUDES AVE
Second Line	:	STE B
City	:	LA MIRADA
State	:	CA
Zip	:	90638-2533
Country	:	US
Telephone Number	:	562-947-8832
Fax Number	:	562-947-8839

Provider Business Practice Location Address
First Line	:	12627 SANTA GERTRUDES AVE
Second Line	:	STE B
City	:	LA MIRADA
State	:	CA
Zip	:	90638-2533
Country	:	US
Telephone Number	:	714-905-2669
Fax Number	:	562-947-8839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/02/2020

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