Provider Demographics
NPI:1629101035
Name:GUARISCO, ANTHONY NMN JR (BSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:NMN
Last Name:GUARISCO
Suffix:JR
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1731
Mailing Address - Country:US
Mailing Address - Phone:954-567-7141
Mailing Address - Fax:954-703-2029
Practice Address - Street 1:871 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1731
Practice Address - Country:US
Practice Address - Phone:954-567-7141
Practice Address - Fax:954-703-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679083600Medicaid