Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003117771 |
---|---|
Provider Name | Gustavo Adolfo Guevara |
First Address | Springfield, MA 01105-1864 |
Second Address | Springfield, MA 01105-1864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |