Provider Demographics
NPI:1497410757
Name:GUZMAN, SUSIE RUTH (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:RUTH
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 BLUFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-7581
Mailing Address - Country:US
Mailing Address - Phone:202-352-0899
Mailing Address - Fax:
Practice Address - Street 1:1071 BLUFFVIEW DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-7581
Practice Address - Country:US
Practice Address - Phone:202-352-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.00293122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry