Provider Demographics
NPI:1689373490
Name:GUERRERO, NICOLE ANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANDREA
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EDMUND ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1823
Mailing Address - Country:US
Mailing Address - Phone:646-715-2622
Mailing Address - Fax:
Practice Address - Street 1:20 EDMUND ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1823
Practice Address - Country:US
Practice Address - Phone:646-715-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker