Basic Information
| Provider Information | |||||||||
| NPI: | 1124530894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBI GUZMAN | ||||||||
| FirstName: | JUANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MCH-LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 BRONXWOOD AVE APT 9 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104664513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9292635941 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8930 114TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114183028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186594000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2017 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.