MEDICARE: ROBERTA GUEZ LICSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	105963-1	MA

General Provider Information

NPI Number	:	1457894859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA GUEZ LICSW

Provider Business Mailing Address
First Line	:	270 CENTRE ST
Second Line	:	SUITE E
City	:	HOLBROOK
State	:	MA
Zip	:	02343-1073
Country	:	US
Telephone Number	:	781-575-0672
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 CENTRE ST
Second Line	:	SUITE E
City	:	HOLBROOK
State	:	MA
Zip	:	02343-1073
Country	:	US
Telephone Number	:	781-575-0672
Fax Number	:

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

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	12/02/2016

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