Provider Demographics
NPI:1700188752
Name:GUGGENHEIM, DAVID A (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GUGGENHEIM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4401
Mailing Address - Country:US
Mailing Address - Phone:212-271-7200
Mailing Address - Fax:212-937-4893
Practice Address - Street 1:230 W 17TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-271-7200
Practice Address - Fax:212-937-4893
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05043370Medicaid