1104962117 NPI number — NICHOLE E GUZZY M.S.ED., PCC - SUPV

Table of content: NICHOLE E GUZZY M.S.ED., PCC - SUPV (NPI 1104962117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104962117 NPI number — NICHOLE E GUZZY M.S.ED., PCC - SUPV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZZY
Provider First Name:
NICHOLE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.ED., PCC - SUPV
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104962117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2680 S SCHENLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44511-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-518-2524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8544 HICKORY HILL DR STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44514-5262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-259-0426
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

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: 101YP2500X , with the licence number:  E.0008400 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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