Provider Demographics
NPI:1366682411
Name:GUIDA, SUSAN JEAN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEAN
Last Name:GUIDA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:GUIDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:43 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1003
Mailing Address - Country:US
Mailing Address - Phone:516-621-2854
Mailing Address - Fax:516-621-2854
Practice Address - Street 1:626 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1149
Practice Address - Country:US
Practice Address - Phone:516-621-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO69724 11041C0700X
NVR069724 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical