Provider Demographics
NPI:1881392397
Name:GARZON, EDITH JOHANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:JOHANNA
Last Name:GARZON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S HEMINGWAY CIR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5380
Mailing Address - Country:US
Mailing Address - Phone:786-712-8598
Mailing Address - Fax:
Practice Address - Street 1:4800 S HEMINGWAY CIR
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5380
Practice Address - Country:US
Practice Address - Phone:786-712-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-05-12
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-05-11
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW211651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker