Provider Demographics
NPI:1700244084
Name:GUZMAN, ZACHARY L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:L
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5625
Mailing Address - Country:US
Mailing Address - Phone:719-327-2059
Mailing Address - Fax:719-636-1116
Practice Address - Street 1:630 E LAS ANIMAS ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4422
Practice Address - Country:US
Practice Address - Phone:928-853-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099260621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO062306OtherRCCF