Provider Demographics
NPI:1114778677
Name:GUILLEN, KYANNA YAZMIN
Entity Type:Individual
Prefix:
First Name:KYANNA
Middle Name:YAZMIN
Last Name:GUILLEN
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 1:367 ALBANY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2564
Mailing Address - Country:US
Mailing Address - Phone:781-513-2871
Mailing Address - Fax:
Practice Address - Street 1:367 ALBANY AVE APT 1
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2564
Practice Address - Country:US
Practice Address - Phone:781-513-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist