Healthcare Provider Details

I. General information

NPI: 1164277125
Provider Name (Legal Business Name): AMY NICOLE GUZZARDI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N COURTHOUSE RD
NORTH CHESTERFIELD VA
23236-4045
US

IV. Provider business mailing address

3425 CUTSHAW AVE
RICHMOND VA
23230-5013
US

V. Phone/Fax

Practice location:
  • Phone: 804-924-2236
  • Fax:
Mailing address:
  • Phone: 540-661-6096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: