Healthcare Provider Details

I. General information

NPI: 1174932263
Provider Name (Legal Business Name): VERUZCA GUZMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERUZCA MUNOZ

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 5TH ST
STAMFORD CT
06905-5012
US

IV. Provider business mailing address

575 MAIN ST FL 2
MIDDLETOWN CT
06457-2845
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-8160
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: