Provider Demographics
NPI:1841314176
Name:GUERINO, SUSAN MAPES (LAC, MAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAPES
Last Name:GUERINO
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WELLSPRING DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1360
Mailing Address - Country:US
Mailing Address - Phone:302-832-7459
Mailing Address - Fax:
Practice Address - Street 1:9170 STATE ROUTE 108 STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1917
Practice Address - Country:US
Practice Address - Phone:410-730-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist