Provider Demographics
NPI:1356693923
Name:GARCIA, MAYRA (MS CCC-SLP TSHH-BE)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS CCC-SLP TSHH-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 JUMEL PL
Mailing Address - Street 2:A 225 DLC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4316
Mailing Address - Country:US
Mailing Address - Phone:212-923-4057
Mailing Address - Fax:
Practice Address - Street 1:21 JUMEL PL
Practice Address - Street 2:A 225 DLC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4316
Practice Address - Country:US
Practice Address - Phone:212-923-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist