1508190521 NPI number — MS. CHRISTINE ANN GUERRERA LMFT

Table of content: MS. CHRISTINE ANN GUERRERA LMFT (NPI 1508190521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508190521 NPI number — MS. CHRISTINE ANN GUERRERA LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRERA
Provider First Name:
CHRISTINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALANDRO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508190521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 HERITAGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-260-9353
Provider Business Mailing Address Fax Number:
203-445-1624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-260-9353
Provider Business Practice Location Address Fax Number:
203-445-1624
Provider Enumeration Date:
09/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  001024 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008057896 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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