Provider Demographics
NPI:1871063784
Name:GUERIN, MICHAEL LOUIS (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:GUERIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1539
Mailing Address - Country:US
Mailing Address - Phone:716-566-7771
Mailing Address - Fax:716-873-0564
Practice Address - Street 1:262 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1539
Practice Address - Country:US
Practice Address - Phone:716-566-7771
Practice Address - Fax:716-873-0564
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102721-1104100000X
NY091628-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker