MEDICARE: MARTHA L GARCIA PHD, LCSW-R

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	103TP2701X	Group Psychotherapy Psychologist	R073581	NY
2	1041C0700X	Clinical Social Worker	R073581	NY

General Provider Information

NPI Number	:	1386537678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA L GARCIA PHD, LCSW-R

Provider Business Mailing Address
First Line	:	7610 34TH AVE APT 6L
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2241
Country	:	US
Telephone Number	:	646-208-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	7610 34TH AVE APT 6L
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2241
Country	:	US
Telephone Number	:	646-208-2707
Fax Number	:

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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