Provider Demographics
NPI:1457520207
Name:GARCIA, EDWIN (MA)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3337
Mailing Address - Country:US
Mailing Address - Phone:484-221-9135
Mailing Address - Fax:484-221-9130
Practice Address - Street 1:3803 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3337
Practice Address - Country:US
Practice Address - Phone:484-221-9135
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health