Provider Demographics
NPI:1639642432
Name:GARCIA, JUAN RAMON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:RAMON
Last Name:GARCIA
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 1:3670 NE INDIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4116
Mailing Address - Country:US
Mailing Address - Phone:772-919-1978
Mailing Address - Fax:
Practice Address - Street 1:3670 NE INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4116
Practice Address - Country:US
Practice Address - Phone:772-919-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW109241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW10924OtherBOARD OF CSW/MFT/MHC