Provider Demographics
NPI:1184992141
Name:FALCON-GARCIA, ANA MARIA (M DIV,CCDP-D, LADC)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:FALCON-GARCIA
Suffix:
Gender:F
Credentials:M DIV,CCDP-D, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2170
Mailing Address - Country:US
Mailing Address - Phone:860-456-2261
Mailing Address - Fax:860-450-1357
Practice Address - Street 1:1007 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2170
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:860-450-1357
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0040040564Medicaid
CTC00570Medicare PIN