Provider Demographics
NPI:1457099178
Name:GUILFOY, MARTIN FRANCIS (LADC I)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FRANCIS
Last Name:GUILFOY
Suffix:
Gender:M
Credentials:LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WHITON AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7309
Mailing Address - Country:US
Mailing Address - Phone:617-691-3632
Mailing Address - Fax:
Practice Address - Street 1:604 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7211
Practice Address - Country:US
Practice Address - Phone:866-682-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13221101YA0400X
13221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)