Provider Demographics
NPI:1669031183
Name:GUZMAN, KATHLEEN (LSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LUCHT PL
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4204
Mailing Address - Country:US
Mailing Address - Phone:201-401-3707
Mailing Address - Fax:
Practice Address - Street 1:100 LUCHT PL
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-4204
Practice Address - Country:US
Practice Address - Phone:201-401-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker