Provider Demographics
NPI:1962610717
Name:GUARIGUATA, INES (LCSW, LCAT, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:INES
Middle Name:
Last Name:GUARIGUATA
Suffix:
Gender:F
Credentials:LCSW, LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 7TH AVE # 139
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1803
Mailing Address - Country:US
Mailing Address - Phone:929-325-1347
Mailing Address - Fax:347-338-2090
Practice Address - Street 1:130 7TH AVE # 139
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1803
Practice Address - Country:US
Practice Address - Phone:929-325-1347
Practice Address - Fax:347-338-2090
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000162221700000X
NY0830001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-4729313OtherEMPLOYER IDENTIFICATION #