Provider Demographics
NPI:1306612312
Name:GUAJARDO-MOORE, ISABELLA S (BA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:S
Last Name:GUAJARDO-MOORE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 FOXRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3625
Mailing Address - Country:US
Mailing Address - Phone:860-948-0963
Mailing Address - Fax:
Practice Address - Street 1:395 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3779
Practice Address - Country:US
Practice Address - Phone:413-310-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor