Healthcare Provider Details

I. General information

NPI: 1558171413
Provider Name (Legal Business Name): KATHERINE C GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 S MAIN ST
CHESHIRE CT
06410-3149
US

IV. Provider business mailing address

1141 RACEBROOK RD
WOODBRIDGE CT
06525-1817
US

V. Phone/Fax

Practice location:
  • Phone: 203-271-1430
  • Fax:
Mailing address:
  • Phone: 203-889-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: