Healthcare Provider Details

I. General information

NPI: 1700714854
Provider Name (Legal Business Name): PATRICIA ANDREA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 LAKEWOOD RD
PINE BUSH NY
12566-7208
US

IV. Provider business mailing address

647 LAKEWOOD RD
PINE BUSH NY
12566-7208
US

V. Phone/Fax

Practice location:
  • Phone: 347-373-4769
  • Fax:
Mailing address:
  • Phone: 347-373-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: