Provider Demographics
NPI:1780831644
Name:GARCIA, LIBET YANIRA
Entity Type:Individual
Prefix:
First Name:LIBET
Middle Name:YANIRA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 URB VALLES DE ANASCO
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9648
Mailing Address - Country:US
Mailing Address - Phone:787-402-3454
Mailing Address - Fax:
Practice Address - Street 1:STREET 360 KM 1.6 INT
Practice Address - Street 2:THE GALLERIA CONFERENCE CENTER SUITE 204 SUITE 205
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2977103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist