Healthcare Provider Details

I. General information

NPI: 1558762831
Provider Name (Legal Business Name): ROBERT GUERRERA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 DANBURY RD
WILTON CT
06897-4405
US

IV. Provider business mailing address

27 DANBURY RD
WILTON CT
06897-4405
US

V. Phone/Fax

Practice location:
  • Phone: 203-210-7820
  • Fax: 203-529-3385
Mailing address:
  • Phone: 203-210-7820
  • Fax: 203-529-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number042713
License Number StateCT

VIII. Authorized Official

Name: ROBERT GUERRERA
Title or Position: OWNER
Credential: M.D.
Phone: 203-210-7820