Provider Demographics
NPI:1770010993
Name:GUARDIANO, THERESA MARIE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:GUARDIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2527
Mailing Address - Country:US
Mailing Address - Phone:607-431-1030
Mailing Address - Fax:607-431-1033
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2527
Practice Address - Country:US
Practice Address - Phone:607-431-1030
Practice Address - Fax:607-431-1033
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0946551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical