Basic Information
| Provider Information | |||||||||
| NPI: | 1730240730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRA | ||||||||
| FirstName: | LUISA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 JEFFERSON STREET | ||||||||
| Address2: | CATHOLIC CHARITIES | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605271124 | ||||||||
| FaxNumber: | 8607242539 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 JEFFERSON STREET | ||||||||
| Address2: | CATHOLIC CHARITIES | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605271124 | ||||||||
| FaxNumber: | 8607242539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| 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 | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.