Healthcare Provider Details

I. General information

NPI: 1033056460
Provider Name (Legal Business Name): CARMELO GUZMAN II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 STATE ST STE 100
SPRINGFIELD MA
01103-1986
US

IV. Provider business mailing address

16 HARRISON PL
EAST HARTFORD CT
06108-3041
US

V. Phone/Fax

Practice location:
  • Phone: 860-374-1759
  • Fax:
Mailing address:
  • Phone:
  • 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: