Provider Demographics
NPI:1669019337
Name:GUYETTE, AMY LISA (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LISA
Last Name:GUYETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1707
Mailing Address - Country:US
Mailing Address - Phone:860-748-2590
Mailing Address - Fax:
Practice Address - Street 1:1089 WOODTICK RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2123
Practice Address - Country:US
Practice Address - Phone:203-879-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional