Provider Demographics
NPI:1013102797
Name:GARCIA, JUAN MANUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
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 1:22741 IRONBARK DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2519
Mailing Address - Country:US
Mailing Address - Phone:626-277-5327
Mailing Address - Fax:
Practice Address - Street 1:1539 W GARVEY AVE N
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2139
Practice Address - Country:US
Practice Address - Phone:626-960-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW85999101YM0800X
CAASW22982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health