Healthcare Provider Details

I. General information

NPI: 1134576887
Provider Name (Legal Business Name): MERY CRUZ GUZMAN BCBA -1-17-28408
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

IV. Provider business mailing address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

V. Phone/Fax

Practice location:
  • Phone: 786-712-3844
  • Fax:
Mailing address:
  • Phone: 786-712-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27564
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-17-28408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: