Provider Demographics
NPI:1447076484
Name:GUZMAN HERRERA, JOHNNY A (LMSW)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:A
Last Name:GUZMAN HERRERA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1275 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2711
Mailing Address - Country:US
Mailing Address - Phone:929-333-4012
Mailing Address - Fax:800-454-0447
Practice Address - Street 1:1547 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3015
Practice Address - Country:US
Practice Address - Phone:929-333-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106494104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker