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NPI Code Detail

MEDICARE: KELLY COLLEEN GUARENTE

MEDICARE:   KELLY COLLEEN GUARENTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-21-48128NC

General Provider Information

NPI Number : 1447724224
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY COLLEEN GUARENTE
Provider Business Mailing Address
First Line : PO BOX 2567
Second Line :
City : AUGUSTA
State : GA
Zip : 30903-2567
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 8509 CROWN CRESCENT CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7733
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2019
Last Update Date : 01/23/2024

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