Healthcare Provider Details

I. General information

NPI: 1093045932
Provider Name (Legal Business Name): SUSAN GUIDA LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2009
Last Update Date: 12/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 DOGWOOD RD
ALBERTSON NY
11507-1003
US

IV. Provider business mailing address

43 DOGWOOD RD
ALBERTSON NY
11507-1003
US

V. Phone/Fax

Practice location:
  • Phone: 516-621-2854
  • Fax: 516-621-2854
Mailing address:
  • Phone: 516-621-2854
  • Fax: 516-621-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number069724-1
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. SUSAN GUIDA
Title or Position: PRESIDENT
Credential: LCSW-R
Phone: 516-621-2854