Provider Demographics
NPI:1366700841
Name:GARCIA, MARY D
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9060
Mailing Address - Country:US
Mailing Address - Phone:915-490-8171
Mailing Address - Fax:575-882-1408
Practice Address - Street 1:101 MAGUEY CT
Practice Address - Street 2:STE. 1
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9513
Practice Address - Country:US
Practice Address - Phone:575-589-2400
Practice Address - Fax:866-591-1407
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst