Provider Demographics
NPI:1073816302
Name:GARGARD, MARIE MONYOU
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MONYOU
Last Name:GARGARD
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 1:1216 ARCH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2835
Mailing Address - Country:US
Mailing Address - Phone:215-981-0088
Mailing Address - Fax:215-864-6931
Practice Address - Street 1:1026 ARCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3002
Practice Address - Country:US
Practice Address - Phone:267-940-5500
Practice Address - Fax:215-207-0640
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker