Provider Demographics
NPI:1114096021
Name:GUARRERA, VINCENT J (DSW)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:GUARRERA
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROWERS LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2120
Mailing Address - Country:US
Mailing Address - Phone:516-829-9362
Mailing Address - Fax:516-829-9362
Practice Address - Street 1:104 BROWERS LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2120
Practice Address - Country:US
Practice Address - Phone:516-829-9362
Practice Address - Fax:516-829-9362
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR009228-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081249OtherVALUE OPTIONS PROVIDER ID
NY081249OtherVALUE OPTIONS PROVIDER ID