Provider Demographics
NPI:1033508601
Name:LOUISSAINT, GUIRLENE
Entity Type:Individual
Prefix:DR
First Name:GUIRLENE
Middle Name:
Last Name:LOUISSAINT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1321
Mailing Address - Country:US
Mailing Address - Phone:631-521-4475
Mailing Address - Fax:
Practice Address - Street 1:11 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1321
Practice Address - Country:US
Practice Address - Phone:631-521-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837864252Y00000X
NY582447111390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program