Provider Demographics
NPI:1497254106
Name:GUILLEN, MARCELINO (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCELINO
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 SAINT RAYMONDS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3115
Mailing Address - Country:US
Mailing Address - Phone:929-266-7204
Mailing Address - Fax:929-296-7443
Practice Address - Street 1:2447 SAINT RAYMONDS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3115
Practice Address - Country:US
Practice Address - Phone:929-266-7204
Practice Address - Fax:929-296-7443
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0816881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty