Provider Demographics
NPI:1588619290
Name:GARVEY, MICHAEL C (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:GARVEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 EXECUTIVE CT N
Mailing Address - Street 2:STE. A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1496
Mailing Address - Country:US
Mailing Address - Phone:707-646-2988
Mailing Address - Fax:707-646-2960
Practice Address - Street 1:420 EXECUTIVE CT N
Practice Address - Street 2:STE. A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1496
Practice Address - Country:US
Practice Address - Phone:707-646-2988
Practice Address - Fax:707-646-2960
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS228011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical