Provider Demographics
NPI:1598866725
Name:GARCIA, RENEE BRADFORD (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:BRADFORD
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 1:19902 KENNEMER DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5063
Mailing Address - Country:US
Mailing Address - Phone:512-965-0748
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUND ROCK AVE
Practice Address - Street 2:#109
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4511
Practice Address - Country:US
Practice Address - Phone:512-965-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612269Medicare ID - Type Unspecified