Provider Demographics
NPI:1912273053
Name:GARCIA, JENNIFER MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:GARCIA
Suffix:
Gender:F
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:D2 CALLE FRONTERA
Mailing Address - Street 2:VILLA ANDALUCIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2507
Mailing Address - Country:US
Mailing Address - Phone:787-200-9888
Mailing Address - Fax:
Practice Address - Street 1:D2 CALLE FRONTERA
Practice Address - Street 2:VILLA ANDALUCIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2507
Practice Address - Country:US
Practice Address - Phone:787-200-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3878103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool