=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225852197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA FRANCES GUIDICE MHC-LP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2024
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 IRVING AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11237-8024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-468-3526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1852 COLDEN AVE APT 2F
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10462-3199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-544-4286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | P124479
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------