Provider Demographics
NPI:1679623888
Name:GUGINO, CORA (CPRP)
Entity Type:Individual
Prefix:MS
First Name:CORA
Middle Name:
Last Name:GUGINO
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 SPRUCE STREET
Mailing Address - Street 2:NORTH COLLINS
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111
Mailing Address - Country:US
Mailing Address - Phone:716-337-3706
Mailing Address - Fax:716-337-2723
Practice Address - Street 1:2107 SPRUCE STREET
Practice Address - Street 2:NORTH COLLINS
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111
Practice Address - Country:US
Practice Address - Phone:716-337-3706
Practice Address - Fax:716-337-2723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health