Provider Demographics
NPI:1477650919
Name:GUADAGNO, MARCIA S
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:S
Last Name:GUADAGNO
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 1:10619 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-4629
Mailing Address - Country:US
Mailing Address - Phone:623-907-0036
Mailing Address - Fax:
Practice Address - Street 1:325 S WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6869
Practice Address - Country:US
Practice Address - Phone:623-772-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ879025Medicare UPIN