Provider Demographics
NPI:1689305534
Name:GUINASSO, MIKE Y
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:Y
Last Name:GUINASSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BAY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2475
Mailing Address - Country:US
Mailing Address - Phone:415-342-1002
Mailing Address - Fax:
Practice Address - Street 1:320 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5291
Practice Address - Country:US
Practice Address - Phone:707-579-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist