Provider Demographics
NPI:1649830449
Name:GARCIA, MARTHA VERONICA (ACSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:VERONICA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MAINE AVE UNIT 419
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-1168
Mailing Address - Country:US
Mailing Address - Phone:310-525-6040
Mailing Address - Fax:
Practice Address - Street 1:18350 MOUNT LANGLEY ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6912
Practice Address - Country:US
Practice Address - Phone:714-450-4118
Practice Address - Fax:714-861-6430
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA900061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical