Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | I-06990 | NM |
N | 1041C0700X | Clinical Social Worker | M-05191 | NM |
NPI | 1003025198 |
---|---|
Provider Name | Tracey E Garcia |
First Address | Espanola, NM 87532-0158 |
Second Address | Espanola, NM 87532-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 13/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89109554 | (05) | NM |