Provider Demographics
NPI:1548396369
Name:GUITER MAZER, IRENE SANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:SANDRA
Last Name:GUITER MAZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:SANDRA
Other - Last Name:MAZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:140 W 79TH ST
Mailing Address - Street 2:SUITE 1F3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6421
Mailing Address - Country:US
Mailing Address - Phone:212-787-5107
Mailing Address - Fax:
Practice Address - Street 1:140 W 79TH ST
Practice Address - Street 2:SUITE 1F3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6421
Practice Address - Country:US
Practice Address - Phone:212-787-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM6291Medicare ID - Type Unspecified