MEDICARE: MR. ZACHARY L GUZMAN LCSW

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	09926062	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	062306	OTHER	CO	RCCF

General Provider Information

NPI Number	:	1700244084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY L GUZMAN LCSW

Provider Business Mailing Address
First Line	:	17 FARRAGUT AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5625
Country	:	US
Telephone Number	:	719-327-2059
Fax Number	:	719-636-1116

Provider Business Practice Location Address
First Line	:	630 E LAS ANIMAS ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4422
Country	:	US
Telephone Number	:	928-853-5019
Fax Number	:

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

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	09/04/2019

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