Provider Demographics
NPI:1285648634
Name:GUARNACCIA, VINCENT (PHD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:GUARNACCIA
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 1:41 ALDERSHOT LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3725
Mailing Address - Country:US
Mailing Address - Phone:516-627-0589
Mailing Address - Fax:516-627-0589
Practice Address - Street 1:41 ALDERSHOT LN
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3725
Practice Address - Country:US
Practice Address - Phone:516-627-0589
Practice Address - Fax:516-627-0589
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0054669OtherPSYCHOLOGIST
NY0054669OtherPSYCHOLOGIST