Provider Demographics
NPI:1457894859
Name:GUEZ, ROBERTA (LICSW)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:GUEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CENTRE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1073
Mailing Address - Country:US
Mailing Address - Phone:781-575-0672
Mailing Address - Fax:
Practice Address - Street 1:270 CENTRE ST
Practice Address - Street 2:SUITE E
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1073
Practice Address - Country:US
Practice Address - Phone:781-575-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105963-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical