Healthcare Provider Details

I. General information

NPI: 1063904936
Provider Name (Legal Business Name): JASMIN GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 FRANKLIN ST
LYNN MA
01902-4158
US

IV. Provider business mailing address

12 PINE ST
PEABODY MA
01960-2404
US

V. Phone/Fax

Practice location:
  • Phone: 339-440-7528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: