Provider Demographics
NPI:1407102197
Name:GUEVARA, VIELKA V (LMFT)
Entity Type:Individual
Prefix:MS
First Name:VIELKA
Middle Name:V
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1410
Mailing Address - Country:US
Mailing Address - Phone:617-309-0115
Mailing Address - Fax:
Practice Address - Street 1:10 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2203
Practice Address - Country:US
Practice Address - Phone:508-469-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1786-MH-MF101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA1303287Medicaid
99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1303287OtherMBHP
MAM18633OtherBCBS
MA1004745OtherNHP
MA1303287Medicaid