Provider Demographics
NPI:1881670529
Name:GARCIA, ABBE MARRS (PHD)
Entity Type:Individual
Prefix:
First Name:ABBE
Middle Name:MARRS
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ABBE
Other - Middle Name:LEA
Other - Last Name:MARRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 978
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4318
Mailing Address - Fax:401-444-7865
Practice Address - Street 1:1 HOPPIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-444-8945
Practice Address - Fax:401-444-8742
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00846103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
007056599Medicare ID - Type Unspecified
Q20856Medicare UPIN