Healthcare Provider Details

I. General information

NPI: 1417720228
Provider Name (Legal Business Name): JESSICA MARIE GUZMAN LMHC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 COLUMBUS AVE UNIT 237190
NEW YORK NY
10023-9672
US

IV. Provider business mailing address

178 COLUMBUS AVE UNIT 237190
NEW YORK NY
10023-9672
US

V. Phone/Fax

Practice location:
  • Phone: 917-817-1777
  • Fax:
Mailing address:
  • Phone: 917-817-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: