Provider Demographics
NPI:1811419229
Name:GUERRA, MICHAEL D (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GUERRA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540013
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02454-0013
Mailing Address - Country:US
Mailing Address - Phone:844-722-3681
Mailing Address - Fax:
Practice Address - Street 1:101 CAMBRIDGE ST STE 230
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3767
Practice Address - Country:US
Practice Address - Phone:708-292-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health