Basic Information
| Provider Information | |||||||||
| NPI: | 1891319935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | CANDY | ||||||||
| MiddleName: | RAFENY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 487 GARFIELD AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073054032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476044599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 579 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184852100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2020 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.