Healthcare Provider Details

I. General information

NPI: 1902493901
Provider Name (Legal Business Name): CLAIRE SIMONE GUERIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MILLER AVE STE A3
MILL VALLEY CA
94941-2844
US

IV. Provider business mailing address

PO BOX 549
MILL VALLEY CA
94942-0549
US

V. Phone/Fax

Practice location:
  • Phone: 323-835-4332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number82848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: