Provider Demographics
NPI:1255794384
Name:GUZMAN, CHAVEL PAMELA
Entity type:Individual
Prefix:
First Name:CHAVEL
Middle Name:PAMELA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 143RD ST
Mailing Address - Street 2:17D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1522
Mailing Address - Country:US
Mailing Address - Phone:347-355-5657
Mailing Address - Fax:
Practice Address - Street 1:200 W 143RD ST
Practice Address - Street 2:17D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:347-355-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSJ58401XMedicaid