Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 3907 | HI |
NPI | 1003239278 |
---|---|
Provider Name | Lynn Garcia |
First Address | Pukalani, HI 96788-0605 |
Second Address | Makawao, HI 96768-7505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2014 |
Last Update Date | 24/01/2014 |