MEDICARE: SONIA A GUIDO LCSW LCADC

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
1	104100000X	Social Worker	44SL05482500	NJ

General Provider Information

NPI Number	:	1467622282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA A GUIDO LCSW LCADC

Provider Business Mailing Address
First Line	:	1076 STATE ROUTE 18
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4355
Country	:	US
Telephone Number	:	732-637-9415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 STATE ROUTE 18
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4355
Country	:	US
Telephone Number	:	732-637-9415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	02/26/2020

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