Provider Demographics
NPI:1467945493
Name:GARCIA, MIGUEL J (LCSW 112411)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:J
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LCSW 112411
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 BLOOMFIELD AVE APT 145
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-1404
Mailing Address - Country:US
Mailing Address - Phone:562-341-0756
Mailing Address - Fax:
Practice Address - Street 1:11015 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4601
Practice Address - Country:US
Practice Address - Phone:562-906-2676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913861041C0700X
CA1124111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical