MEDICARE: MRS. MARCOLINA GARCIA LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	000952	CT

General Provider Information

NPI Number	:	1437592128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCOLINA GARCIA LADC

Provider Business Mailing Address
First Line	:	PO BOX 1674
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06144-1674
Country	:	US
Telephone Number	:	860-893-0089
Fax Number	:	860-893-0200

Provider Business Practice Location Address
First Line	:	1 GROVE ST
Second Line	:	2ND FLOOR
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-4116
Country	:	US
Telephone Number	:	860-893-0089
Fax Number	:	860-893-0200

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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