Healthcare Provider Details

I. General information

NPI: 1447882394
Provider Name (Legal Business Name): JORDAN MICHAEL GUEDES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 SW 17TH AVE APT 10
MIAMI FL
33145-2756
US

IV. Provider business mailing address

1912 SW 17TH AVE APT 10
MIAMI FL
33145-2756
US

V. Phone/Fax

Practice location:
  • Phone: 305-987-2785
  • Fax:
Mailing address:
  • Phone: 305-987-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: