Provider Demographics
NPI:1558696997
Name:GARCIA, CRYSTAL LEE (LMSW/MSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMSW/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 BROADWAY GREENLAWN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5556
Mailing Address - Country:US
Mailing Address - Phone:631-651-8229
Mailing Address - Fax:
Practice Address - Street 1:115 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3676
Practice Address - Country:US
Practice Address - Phone:631-234-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP730861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical