Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS1159 | ME |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS1159 | ME |
N | 103G00000X | Clinical Psychologist | PS1159 | ME |
N | 103TC0700X | Clinical Psychologist | PS1159 | ME |
NPI | 1376501833 |
---|---|
Provider Name | Dr. Joel Guarna |
First Address | Portland, ME 04101-4212 |
Second Address | Portland, ME 04101-4212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187815 | ANTHEM BLUE CROSS BLUE SH (01) | ME |
302912 | TRICARE (01) | NH |