Provider Demographics
NPI:1144662800
Name:GUARINO, MICHELLE JUDITH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JUDITH
Last Name:GUARINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROUTE 111
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3739
Mailing Address - Country:US
Mailing Address - Phone:631-656-9550
Mailing Address - Fax:631-656-9551
Practice Address - Street 1:11 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3739
Practice Address - Country:US
Practice Address - Phone:631-656-9550
Practice Address - Fax:631-656-9551
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0851921041C0700X
NY0904491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical