Provider Demographics
NPI:1891521019
Name:MINAYA GUZMAN, ROSANNY
Entity type:Individual
Prefix:
First Name:ROSANNY
Middle Name:
Last Name:MINAYA GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 PHELAN PL APT 3I
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5143
Mailing Address - Country:US
Mailing Address - Phone:718-306-7959
Mailing Address - Fax:
Practice Address - Street 1:1834 PHELAN PL APT 3I
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5143
Practice Address - Country:US
Practice Address - Phone:718-306-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY3079083103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician