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General NPI Number Information
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NPI Number | 1295103497
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Entity Type | Individual
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Provider Name | ILEANA GUZMAN LCSW-S
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 301 BULLDOG BLVD
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City | ARTESIA
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State | NM
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Zip | 88210-1731
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Country | US
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Telephone | 575-808-9520
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Fax |
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Provider Business Mailing Address
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Address Line | 47 DIANE ST
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City | ARTESIA
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State | NM
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Zip | 88210-9229
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Country | US
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Telephone | 575-808-9520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-11745
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | X-09269
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License Number State | NM
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