MEDICARE: ELIZABETH GARCIA

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst		IL

General Provider Information

NPI Number	:	1124500640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GARCIA

Provider Business Mailing Address
First Line	:	4908 W 24TH PL
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-3420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7222 W CERMAK RD STE 500
Second Line	:
City	:	NORTH RIVERSIDE
State	:	IL
Zip	:	60546-1443
Country	:	US
Telephone Number	:	773-747-0626
Fax Number	:	708-853-9737

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	05/08/2023

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