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General NPI Number Information
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NPI Number | 1710511407
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Entity Type | Individual
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Provider Name | KRISTEN GUSKOVICT LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 18191 NW 68TH AVE
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City | HIALEAH
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State | FL
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Zip | 33015-3996
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Country | US
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Telephone | 917-629-6231
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 E TREASURE DR APT 1812
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4367
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Country | US
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Telephone | 917-628-6231
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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 | 14557
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License Number State | FL
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