Provider Demographics
NPI:1689036287
Name:GUZMAN, ANDRIS INMACULADA (BA)
Entity Type:Individual
Prefix:
First Name:ANDRIS
Middle Name:INMACULADA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 MARION AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2278
Mailing Address - Country:US
Mailing Address - Phone:347-331-9626
Mailing Address - Fax:
Practice Address - Street 1:2970 MARION AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2278
Practice Address - Country:US
Practice Address - Phone:347-331-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1005382161103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst