Provider Demographics
NPI:1588698070
Name:GUIDO, STEPHEN MICHAEL (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:GUIDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CROOKED HILL ROAD
Mailing Address - Street 2:SUITE 203-E
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-462-5344
Mailing Address - Fax:631-462-9133
Practice Address - Street 1:35 CROOKED HILL RD
Practice Address - Street 2:SUITE 203-E
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5415
Practice Address - Country:US
Practice Address - Phone:631-462-5344
Practice Address - Fax:631-462-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical