Provider Demographics
NPI:1447628292
Name:GUZMAN, UBALDINA
Entity type:Individual
Prefix:
First Name:UBALDINA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UBALDINA
Other - Middle Name:
Other - Last Name:GUZMAN NUNEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:2826 SAMPSON AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2917
Mailing Address - Country:US
Mailing Address - Phone:646-633-7308
Mailing Address - Fax:
Practice Address - Street 1:2826 SAMPSON AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2917
Practice Address - Country:US
Practice Address - Phone:646-633-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088556-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker