Healthcare Provider Details

I. General information

NPI: 1245553726
Provider Name (Legal Business Name): CARLOS EDUARDO GUZMAN MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HIGH ST
EASTHAMPTON MA
01027-1440
US

IV. Provider business mailing address

23 HIGH STREET
EASTHAMPTON MA
01207-1333
US

V. Phone/Fax

Practice location:
  • Phone: 413-854-7697
  • Fax:
Mailing address:
  • Phone: 413-854-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122890
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: