Healthcare Provider Details

I. General information

NPI: 1568835650
Provider Name (Legal Business Name): LYCIA ALEXANDER-GUERRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13919 CARROLLWOOD VILLAGE RUN
TAMPA FL
33618-2746
US

IV. Provider business mailing address

13919 CARROLLWOOD VILLAGE RUN
TAMPA FL
33618-2746
US

V. Phone/Fax

Practice location:
  • Phone: 813-908-5080
  • Fax: 813-908-5081
Mailing address:
  • Phone: 813-908-5080
  • Fax: 813-908-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberME45611
License Number StateFL

VIII. Authorized Official

Name: DR. LYCIA L ALEXANDER-GUERRA
Title or Position: MD
Credential: MD
Phone: 813-908-5080