Provider Demographics
NPI:1013177997
Name:GUILLEN, SOBEIRA A (LCSW-R)
Entity Type:Individual
Prefix:
First Name:SOBEIRA
Middle Name:A
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GRAND CONCOURSE FRNT OFFICE5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3003
Mailing Address - Country:US
Mailing Address - Phone:551-574-3699
Mailing Address - Fax:718-401-2322
Practice Address - Street 1:800 GRND CONCRS FRNT OFFICE5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3003
Practice Address - Country:US
Practice Address - Phone:551-574-3699
Practice Address - Fax:718-401-2322
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053580001041C0700X
NYR069912-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03062159Medicaid
A300000269Medicare PIN