Healthcare Provider Details

I. General information

NPI: 1356785174
Provider Name (Legal Business Name): CARMEN M GUZMAN NEGRETE CBHCMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

IV. Provider business mailing address

4883 FELLS COVE AVE
KISSIMMEE FL
34744-9250
US

V. Phone/Fax

Practice location:
  • Phone: 407-789-6928
  • Fax: 321-256-5799
Mailing address:
  • Phone: 407-271-3794
  • Fax: 321-256-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS100474
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: