MEDICARE: MARCELINO GUILLEN LCSW

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	1041C0700X	Clinical Social Worker	081688	NY

General Provider Information

NPI Number	:	1497254106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELINO GUILLEN LCSW

Provider Business Mailing Address
First Line	:	2447 SAINT RAYMONDS AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3115
Country	:	US
Telephone Number	:	929-266-7204
Fax Number	:	929-296-7443

Provider Business Practice Location Address
First Line	:	2447 SAINT RAYMONDS AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3115
Country	:	US
Telephone Number	:	929-266-7204
Fax Number	:	929-296-7443

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	06/27/2022

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