Healthcare Provider Details

I. General information

NPI: 1104341593
Provider Name (Legal Business Name): ALEXANDER GUZMAN SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-120 QUEENS BLVD
REGO PARK NY
11374
US

IV. Provider business mailing address

11023 SPRINGFIELD BLVD PH
QUEENS VILLAGE NY
11429-2520
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax: 718-830-9088
Mailing address:
  • Phone: 718-506-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085780-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: