Healthcare Provider Details

I. General information

NPI: 1508019704
Provider Name (Legal Business Name): LIZETTE GUZMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LIZETTE GONZALEZ

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 14TH ST
MODESTO CA
95354-2506
US

IV. Provider business mailing address

707 14TH ST
MODESTO CA
95354-2506
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-5401
  • Fax:
Mailing address:
  • Phone: 209-525-5401
  • Fax: 209-567-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: