Provider Demographics
NPI:1154436970
Name:GARCIA, GILBERT E (MSW,ACSW, LCSW)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MSW,ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-1520
Mailing Address - Country:US
Mailing Address - Phone:906-864-2208
Mailing Address - Fax:906-864-2558
Practice Address - Street 1:3612 13TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-1520
Practice Address - Country:US
Practice Address - Phone:906-864-2208
Practice Address - Fax:906-864-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI765-1231041C0700X
MI68010658871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26230Medicare ID - Type Unspecified