Healthcare Provider Details

I. General information

NPI: 1659431518
Provider Name (Legal Business Name): THE CHILD AND FAMILY GUIDANCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FAIRFIELD AVE
BRIDGEPORT CT
06604-4252
US

IV. Provider business mailing address

180 FAIRFIELD AVE
BRIDGEPORT CT
06604-4252
US

V. Phone/Fax

Practice location:
  • Phone: 203-394-6529
  • Fax: 203-394-6534
Mailing address:
  • Phone: 203-394-6529
  • Fax: 203-394-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. L. PHILIP GUZMAN
Title or Position: PRESIDENT CEO
Credential: PH.D
Phone: 203-394-6529