Healthcare Provider Details

I. General information

NPI: 1457502726
Provider Name (Legal Business Name): ERIKA LARA GUZMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-12 W PARK AVE SUITE 200
LONG BEACH NY
11561-2025
US

IV. Provider business mailing address

2-12 W PARK AVE SUITE 200
LONG BEACH NY
11561-2025
US

V. Phone/Fax

Practice location:
  • Phone: 516-889-2332
  • Fax:
Mailing address:
  • Phone: 516-889-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP02621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: