Healthcare Provider Details

I. General information

NPI: 1649188186
Provider Name (Legal Business Name): SHANNA P GUTHRIE CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

IV. Provider business mailing address

1623 KINGS HWY
BROOKLYN NY
11229-1209
US

V. Phone/Fax

Practice location:
  • Phone: 929-636-5917
  • Fax:
Mailing address:
  • Phone: 929-636-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCASAC-T-42623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: