Provider Demographics
NPI:1144222712
Name:GUGGENHEIM, STEVEN ROGER (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROGER
Last Name:GUGGENHEIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 PALMER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2483
Mailing Address - Country:US
Mailing Address - Phone:914-714-4426
Mailing Address - Fax:914-834-6222
Practice Address - Street 1:2039 PALMER AVE
Practice Address - Street 2:STE 201
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2483
Practice Address - Country:US
Practice Address - Phone:914-714-4426
Practice Address - Fax:914-834-6222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12230-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01914745Medicaid
NYV3J601Medicare ID - Type Unspecified