Provider Demographics
NPI:1154839009
Name:GUIDA, RICHELE
Entity Type:Individual
Prefix:
First Name:RICHELE
Middle Name:
Last Name:GUIDA
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 1:650 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2601
Mailing Address - Country:US
Mailing Address - Phone:408-283-8555
Mailing Address - Fax:408-279-4825
Practice Address - Street 1:650 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2601
Practice Address - Country:US
Practice Address - Phone:408-283-8555
Practice Address - Fax:408-279-4825
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA04499101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)