Provider Demographics
NPI:1104341593
Name:GUZMAN, ALEXANDER (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 SPRINGFIELD BLVD PH
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2520
Mailing Address - Country:US
Mailing Address - Phone:718-506-6388
Mailing Address - Fax:
Practice Address - Street 1:98-120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:718-830-9088
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085780-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical