Provider Demographics
NPI:1457782674
Name:GUERREO, GINO
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:GUERREO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1DE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2611
Mailing Address - Country:US
Mailing Address - Phone:347-577-5844
Mailing Address - Fax:347-577-5845
Practice Address - Street 1:2940 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1DE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2611
Practice Address - Country:US
Practice Address - Phone:347-577-5844
Practice Address - Fax:347-577-5845
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health