Provider Demographics
NPI:1891453783
Name:GUERRA, GISELLE MARY (BCBA)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:MARY
Last Name:GUERRA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 ALDERTON ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5322
Mailing Address - Country:US
Mailing Address - Phone:347-575-8428
Mailing Address - Fax:
Practice Address - Street 1:6919 ALDERTON ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5322
Practice Address - Country:US
Practice Address - Phone:347-575-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002232OtherLICENSED BEHAVIOR ANALYST