Provider Demographics
NPI:1720157159
Name:GUARINO-MINASSIAN, LORRAINE (PT, CSCS)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:GUARINO-MINASSIAN
Suffix:
Gender:F
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 ROUTE 303 # 11
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1105
Mailing Address - Country:US
Mailing Address - Phone:845-680-6655
Mailing Address - Fax:845-680-6655
Practice Address - Street 1:580 ROUTE 303 # 11
Practice Address - Street 2:WESTSHORE PLAZA
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1105
Practice Address - Country:US
Practice Address - Phone:845-680-6655
Practice Address - Fax:845-680-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist