Provider Demographics
NPI:1235482423
Name:GARCIA, JAZMIN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JAZMIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1967
Mailing Address - Country:US
Mailing Address - Phone:313-369-4730
Mailing Address - Fax:313-368-8297
Practice Address - Street 1:62 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1967
Practice Address - Country:US
Practice Address - Phone:313-369-4730
Practice Address - Fax:313-368-8297
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010931941041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN99590024OtherINDIVIDUAL MEDICARE PTAN