Provider Demographics
NPI:1265126437
Name:GARCIA GARCIA, ERIDANIA DOLORES (LMSW)
Entity type:Individual
Prefix:MS
First Name:ERIDANIA
Middle Name:DOLORES
Last Name:GARCIA GARCIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ERIDANIA
Other - Middle Name:DOLORES
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 BEACH 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11420
Mailing Address - Country:US
Mailing Address - Phone:347-525-7857
Mailing Address - Fax:
Practice Address - Street 1:720 BEACH 20TH STREET
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-327-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker