Provider Demographics
NPI:1801400940
Name:GURICO, ALEXANDER NICHOALS (INTERN CANDIDATE MSW)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NICHOALS
Last Name:GURICO
Suffix:
Gender:M
Credentials:INTERN CANDIDATE MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WESLEYAN RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2518
Mailing Address - Country:US
Mailing Address - Phone:631-670-6990
Mailing Address - Fax:
Practice Address - Street 1:11 WESLEYAN RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2518
Practice Address - Country:US
Practice Address - Phone:516-424-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical