Provider Demographics
NPI:1780112599
Name:GARCIA, MARIE YVETTE (LMSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:YVETTE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GALLINAS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3826
Mailing Address - Country:US
Mailing Address - Phone:505-454-8882
Mailing Address - Fax:505-426-0190
Practice Address - Street 1:2020 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4958
Practice Address - Country:US
Practice Address - Phone:505-587-1050
Practice Address - Fax:877-553-1272
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-0592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71076743Medicaid