Provider Demographics
NPI:1033602586
Name:GARCIA, MARICRUZ
Entity Type:Individual
Prefix:
First Name:MARICRUZ
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210341
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-0341
Mailing Address - Country:US
Mailing Address - Phone:917-609-7026
Mailing Address - Fax:917-724-0844
Practice Address - Street 1:26 COURT ST STE 1711
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1117
Practice Address - Country:US
Practice Address - Phone:917-609-7026
Practice Address - Fax:917-724-0844
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008114-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health