Basic Information
| Provider Information | |||||||||
| NPI: | 1679623888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUGINO | ||||||||
| FirstName: | CORA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CPRP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2107 SPRUCE STREET | ||||||||
| Address2: | NORTH COLLINS | ||||||||
| City: | NORTH COLLINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163373706 | ||||||||
| FaxNumber: | 7163372723 | ||||||||
| Practice Location | |||||||||
| Address1: | 2107 SPRUCE STREET | ||||||||
| Address2: | NORTH COLLINS | ||||||||
| City: | NORTH COLLINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163373706 | ||||||||
| FaxNumber: | 7163372723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 169268 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.