Healthcare Provider Details

I. General information

NPI: 1255914917
Provider Name (Legal Business Name): BRIEL M GUZMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WESTCHESTER AVE
BRONX NY
10459-3009
US

IV. Provider business mailing address

1776 CLAY AVE
BRONX NY
10457-7239
US

V. Phone/Fax

Practice location:
  • Phone: 718-764-1570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112359
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: