Provider Demographics
NPI:1184905721
Name:GUZMAN, ANNETTE (MA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 183 R 916
Mailing Address - Street 2:K 1 6.0
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-477-8406
Mailing Address - Fax:787-746-8079
Practice Address - Street 1:HC 20 BOX 26307
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9653
Practice Address - Country:US
Practice Address - Phone:787-477-8406
Practice Address - Fax:787-746-8079
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3111103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling