Healthcare Provider Details

I. General information

NPI: 1790258119
Provider Name (Legal Business Name): NEFTALI B. GUZMAN SERVICE PROVIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NEFTALI B. GUZMAN SERVICE PROVIDER

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 E 29TH ST
BROOKLYN NY
11210-2927
US

IV. Provider business mailing address

858 E 29TH ST
BROOKLYN NY
11210-2927
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-4500
  • Fax:
Mailing address:
  • Phone: 718-859-4500
  • 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: