Provider Demographics
NPI:1275921611
Name:GARCIA, MANUELA (LCSW)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:GARCIA
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 1:415 CLAREMONT AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1816
Mailing Address - Country:US
Mailing Address - Phone:201-406-9854
Mailing Address - Fax:
Practice Address - Street 1:415 CLAREMONT AVE APT 2D
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1816
Practice Address - Country:US
Practice Address - Phone:201-406-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05594300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health