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NPI Code Detail

MEDICARE: THE CHILD AND FAMILY GUIDANCE CENTER, INC.

MEDICARE: THE CHILD AND FAMILY GUIDANCE CENTER, INC.
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
11041C0700XClinical Social Worker
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659431518
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE CHILD AND FAMILY GUIDANCE CENTER, INC.
Provider Business Mailing Address
First Line : 180 FAIRFIELD AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-4252
Country : US
Telephone Number : 203-394-6529
Fax Number : 203-394-6534
Provider Business Practice Location Address
First Line : 180 FAIRFIELD AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-4252
Country : US
Telephone Number : 203-394-6529
Fax Number : 203-394-6534
Authorized Official
Title or Position : PRESIDENT CEO
Name : DR. L. PHILIP GUZMAN
Credential : PH.D
Telephone Number : 203-394-6529
Provider Enumeration Date : 12/11/2006
Last Update Date : 12/23/2014

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06604-4252
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Directions to “THE CHILD AND FAMILY GUIDANCE CENTER, INC. ” Practice Location

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