Provider Demographics
NPI:1609396225
Name:GARCIA, ELBA I (MS ED)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:I
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 GRAND CONCOURSE APT 5K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5562
Mailing Address - Country:US
Mailing Address - Phone:917-549-0591
Mailing Address - Fax:
Practice Address - Street 1:1770 GRAND CONCOURSE APT 5K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5562
Practice Address - Country:US
Practice Address - Phone:917-549-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY92109103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst