Provider Demographics
NPI:1366705865
Name:GUEVARA, MARIA CARMELA (MSED)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CARMELA
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 181ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2142
Mailing Address - Country:US
Mailing Address - Phone:718-359-8244
Mailing Address - Fax:718-359-2093
Practice Address - Street 1:6422 181ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-2142
Practice Address - Country:US
Practice Address - Phone:718-359-8244
Practice Address - Fax:718-359-2093
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641279174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency