Provider Demographics
NPI:1790946952
Name:ROBERT GUARCELLO, PSYCHOLOGY,PC
Entity Type:Organization
Organization Name:ROBERT GUARCELLO, PSYCHOLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GUARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-877-0404
Mailing Address - Street 1:226 7TH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5723
Mailing Address - Country:US
Mailing Address - Phone:516-877-0407
Mailing Address - Fax:516-594-6909
Practice Address - Street 1:226 7TH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5723
Practice Address - Country:US
Practice Address - Phone:516-877-0407
Practice Address - Fax:516-594-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6304261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS06304OtherWORKMANS COMP
NYV18161Medicare PIN