Provider Demographics
NPI:1225808777
Name:GARCIA, BRISSTOL (MHC, MFT)
Entity Type:Individual
Prefix:
First Name:BRISSTOL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MHC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BRAINERD RD APT 521
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4590
Mailing Address - Country:US
Mailing Address - Phone:760-505-4034
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 205
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-855-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health