Provider Demographics
NPI:1700212172
Name:GARCIA, ANNETTE Y (MSED,ECSE)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:Y
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MSED,ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 NORMAN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8110
Mailing Address - Country:US
Mailing Address - Phone:718-418-0960
Mailing Address - Fax:
Practice Address - Street 1:1723 NORMAN ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-8110
Practice Address - Country:US
Practice Address - Phone:718-418-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY817152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist