Provider Demographics
NPI:1972931806
Name:GUERIN, JOHN JOSEPH (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:GUERIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3410
Mailing Address - Country:US
Mailing Address - Phone:215-628-8800
Mailing Address - Fax:215-699-1554
Practice Address - Street 1:426 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3410
Practice Address - Country:US
Practice Address - Phone:215-628-8800
Practice Address - Fax:215-699-1554
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004341-L103TC0700X
NJSI-00003704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical