Healthcare Provider Details

I. General information

NPI: 1275811911
Provider Name (Legal Business Name): MS. MELANIE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 ACADEMY ST
NEW YORK NY
10034-5003
US

IV. Provider business mailing address

525 W 169TH ST APT 2A
NEW YORK NY
10032-4039
US

V. Phone/Fax

Practice location:
  • Phone: 212-942-0043
  • Fax:
Mailing address:
  • Phone: 646-221-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0829501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: