Basic Information
Provider Information
NPI: 1003002395
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARAY
FirstName: EDITH
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: BSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11031 NE 6TH AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331617182
CountryCode: US
TelephoneNumber: 3053986100
FaxNumber: 3057574465
Practice Location
Address1: 701 SW 27TH AVE
Address2: ROOM 920
City: MIAMI
State: FL
PostalCode: 331353031
CountryCode: US
TelephoneNumber: 3056437800
FaxNumber: 3056431345
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 09/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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