Provider Demographics
NPI:1295353191
Name:DEGUIRE, DOUGLAS JR (MBA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:DEGUIRE
Suffix:JR
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 E 218TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5806
Mailing Address - Country:US
Mailing Address - Phone:917-346-3382
Mailing Address - Fax:
Practice Address - Street 1:816 E 218TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5806
Practice Address - Country:US
Practice Address - Phone:917-346-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician