Healthcare Provider Details

I. General information

NPI: 1104253392
Provider Name (Legal Business Name): JANE E GUILES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12196 COUNTY ROAD 512
FELLSMERE FL
32948-5463
US

IV. Provider business mailing address

1545 9TH ST SW
VERO BEACH FL
32962-4312
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-8224
  • Fax: 772-213-3157
Mailing address:
  • Phone: 772-257-8224
  • Fax: 772-213-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: