Healthcare Provider Details

I. General information

NPI: 1447076484
Provider Name (Legal Business Name): JOHNNY A GUZMAN HERRERA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN GUZMAN LMSW

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 AUSTIN ST # 102
FOREST HILLS NY
11375-5354
US

IV. Provider business mailing address

7211 AUSTIN ST # 102
FOREST HILLS NY
11375-5354
US

V. Phone/Fax

Practice location:
  • Phone: 929-333-4012
  • Fax: 917-779-8516
Mailing address:
  • Phone: 929-333-4012
  • Fax: 917-779-8516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106494
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: