Provider Demographics
NPI:1205535077
Name:GARCIA-CARMONA, JEAN CARLO (LCSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:CARLO
Last Name:GARCIA-CARMONA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 CALLE ATARDECER
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2337
Mailing Address - Country:US
Mailing Address - Phone:787-366-6088
Mailing Address - Fax:
Practice Address - Street 1:K-31 2ND STREET
Practice Address - Street 2:PRADOS DEL SONADOR
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-366-6088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR137031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical