Healthcare Provider Details

I. General information

NPI: 1275614588
Provider Name (Legal Business Name): JOSEFINA GUERRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JBFCS BRONX REAL 55 WESTCHESTER SQUARE
BRONX NY
10461-3525
US

IV. Provider business mailing address

25 VERMILYEA AVE APT 55
NEW YORK NY
10034-5409
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-4045
  • Fax:
Mailing address:
  • Phone: 917-365-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number061465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: