Basic Information
| Provider Information | |||||||||
| NPI: | 1003153040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRERO | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LYNNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 W MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526304133 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 W MAIN ST | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027401287 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.