Provider Demographics
NPI:1518080878
Name:GUERRA, LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2254
Mailing Address - Country:US
Mailing Address - Phone:516-802-0284
Mailing Address - Fax:516-802-0285
Practice Address - Street 1:185 SOUTH ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2254
Practice Address - Country:US
Practice Address - Phone:516-802-0284
Practice Address - Fax:516-802-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2017-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012231103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02447845Medicaid