MEDICARE: EMILY GUERRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1407305105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GUERRA

Provider Business Mailing Address
First Line	:	198 2ND STREET
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780
Country	:	US
Telephone Number	:	631-291-0244
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 2ND ST
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2027
Country	:	US
Telephone Number	:	631-291-0244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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