Provider Demographics
NPI:1508301359
Name:GARG, KIKI (LMHC)
Entity Type:Individual
Prefix:
First Name:KIKI
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4115
Mailing Address - Country:US
Mailing Address - Phone:518-785-7547
Mailing Address - Fax:
Practice Address - Street 1:339 BROADWAY
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2708
Practice Address - Country:US
Practice Address - Phone:518-465-5201
Practice Address - Fax:518-463-8051
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health