Healthcare Provider Details

I. General information

NPI: 1649417445
Provider Name (Legal Business Name): WENDY JANETTE GUZMAN-ROSA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY JANETTE GUZMAN LMSW

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 LORRAINE TER APT 321
MOUNT VERNON NY
10553-1237
US

IV. Provider business mailing address

73 LORRAINE TER APT 321
MOUNT VERNON NY
10553-1237
US

V. Phone/Fax

Practice location:
  • Phone: 914-772-2290
  • Fax:
Mailing address:
  • Phone: 914-772-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: