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General NPI Number Information
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NPI Number | 1003555186
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Entity Type | Individual
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Provider Name | MARIELL ANDREA GUILLEN
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Gender | Female
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 701 PROMENADE DR STE 250
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-6035
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Country | US
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Telephone | 954-399-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 CAPRI LN APT 3808
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City | WESTON
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State | FL
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Zip | 33326-4023
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Country | US
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Telephone | 832-480-9953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-216616
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License Number State | FL
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