Healthcare Provider Details

I. General information

NPI: 1912069196
Provider Name (Legal Business Name): L. PHILIP GUZMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FAIRFIELD AVE
BRIDGEPORT CT
06604-4252
US

IV. Provider business mailing address

365 PECK LN
ORANGE CT
06477-3335
US

V. Phone/Fax

Practice location:
  • Phone: 203-394-6529
  • Fax: 203-384-8835
Mailing address:
  • Phone: 203-795-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number801
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: