Provider Demographics
NPI:1619948643
Name:GARASCIA, ANTHONY J (MS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:GARASCIA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SAINT LOUIS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3044
Mailing Address - Country:US
Mailing Address - Phone:574-335-8707
Mailing Address - Fax:
Practice Address - Street 1:300 S SAINT LOUIS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3044
Practice Address - Country:US
Practice Address - Phone:574-335-8250
Practice Address - Fax:574-335-0788
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002363A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN738460032OtherMEDICARE
IN000001092437OtherBCBS