Provider Demographics
NPI:1073245825
Name:GUILLEN, ANALIA (MENTAL HEALTH COUNSE)
Entity Type:Individual
Prefix:
First Name:ANALIA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:ANALIA
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3046 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2816
Mailing Address - Country:US
Mailing Address - Phone:718-424-6191
Mailing Address - Fax:718-303-4320
Practice Address - Street 1:3046 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2816
Practice Address - Country:US
Practice Address - Phone:718-424-6191
Practice Address - Fax:718-303-4320
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health