Provider Demographics
NPI:1578804746
Name:GUZMAN, VANESSA (RBT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 JEFFERSON ST NE APT 628
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2264
Mailing Address - Country:US
Mailing Address - Phone:505-675-8563
Mailing Address - Fax:
Practice Address - Street 1:8901 JEFFERSON ST NE APT 628
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2264
Practice Address - Country:US
Practice Address - Phone:505-675-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor