Provider Demographics
NPI:1275083313
Name:GARZA, NIESIA DESHAE (LCSW)
Entity Type:Individual
Prefix:
First Name:NIESIA
Middle Name:DESHAE
Last Name:GARZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7406
Mailing Address - Country:US
Mailing Address - Phone:850-780-3496
Mailing Address - Fax:850-462-2094
Practice Address - Street 1:1754 SEA LARK LN
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7406
Practice Address - Country:US
Practice Address - Phone:850-780-3496
Practice Address - Fax:850-462-2094
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical