=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558164376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH GUERRERO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15924 SW 92ND AVE
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-964-5824
-----------------------------------------------------
Fax | 786-452-1200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15067 SW 103RD TER APT 14103
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33196-3757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-403-0511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ISW21062
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------