Provider Demographics
NPI:1750757720
Name:GUERRA, AUSBERTO J (DMINCDVC-IV)
Entity type:Individual
Prefix:
First Name:AUSBERTO
Middle Name:J
Last Name:GUERRA
Suffix:
Gender:M
Credentials:DMINCDVC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4205
Mailing Address - Country:US
Mailing Address - Phone:847-623-1730
Mailing Address - Fax:847-623-1733
Practice Address - Street 1:329 N GENESEE ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4205
Practice Address - Country:US
Practice Address - Phone:847-623-1730
Practice Address - Fax:847-623-1733
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor