Provider Demographics
NPI:1063795490
Name:GARCIA, LAURA JULIA (MA, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JULIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 E 77TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1947
Mailing Address - Country:US
Mailing Address - Phone:305-984-4149
Mailing Address - Fax:
Practice Address - Street 1:700 E 179TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5006
Practice Address - Country:US
Practice Address - Phone:646-669-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12140439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist