Provider Demographics
NPI:1811059488
Name:SMITH, GUILLERMO ALFREDO
Entity type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:ALFREDO
Last Name:SMITH
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 1:14707 72ND RD
Mailing Address - Street 2:APT. 1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2562
Mailing Address - Country:US
Mailing Address - Phone:718-793-3967
Mailing Address - Fax:
Practice Address - Street 1:40 FLATBUSH AVE. EXT
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-439-4347
Practice Address - Fax:718-439-4356
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health