Basic Information
| Provider Information | |||||||||
| NPI: | 1063627719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRERO | ||||||||
| FirstName: | JEANETHE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M,S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 PONCE DE LEON BLVD STE 378 | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331344418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058585204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9380 SW 72ND ST STE B120 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331735456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052743172 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NONE | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | -- | 05 | FL | MEDICAID |