Provider Demographics
NPI:1346594512
Name:GARCIA, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:405 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1131
Mailing Address - Country:US
Mailing Address - Phone:413-200-8324
Mailing Address - Fax:866-892-0405
Practice Address - Street 1:405 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1131
Practice Address - Country:US
Practice Address - Phone:413-200-8324
Practice Address - Fax:866-892-0405
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1219411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295OtherMBHP
MA71756OtherTUFTS
MA997303OtherNETWORK HEALTH
MA8443OtherBMC/BEACON
MA1303295Medicaid
MA12529OtherHEALTH NEW ENGLAND
MA042622756OtherCOMMONWEALTH CARE ALLIANCE