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General NPI Number Information
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NPI Number | 1366682411
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Entity Type | Individual
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Provider Name | SUSAN JEAN GUIDA LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 626 WILLIS AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1149
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Country | US
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Telephone | 516-621-2854
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Fax |
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Provider Business Mailing Address
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Address Line | 43 DOGWOOD RD
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City | ALBERTSON
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State | NY
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Zip | 11507-1003
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Country | US
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Telephone | 516-621-2854
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Fax | 516-621-2854
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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 | RO69724 1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R069724 1
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License Number State | NV
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