Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS018889 | PA |
Y | 103T00000X | Psychologist | PS018889 | PA |
NPI | 1003466384 |
---|---|
Provider Name | Roberto Carlos Guerra |
First Address | Pittsburgh, PA 15217-2509 |
Second Address | Torrance, PA 15779-9237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |