Provider Demographics
NPI:1801950571
Name:GARVEY, MARY LAURA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LAURA
Last Name:GARVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72855 FRED WARING DR
Mailing Address - Street 2:STE. C-16
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9367
Mailing Address - Country:US
Mailing Address - Phone:760-779-0220
Mailing Address - Fax:760-779-0222
Practice Address - Street 1:72855 FRED WARING DR
Practice Address - Street 2:STE. C-16
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9367
Practice Address - Country:US
Practice Address - Phone:760-779-0220
Practice Address - Fax:760-779-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS158611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00693ZMedicare ID - Type Unspecified