Provider Demographics
NPI:1063242790
Name:GUADAMUZ, MARLA (MSW)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:GUADAMUZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:FABIANA
Other - Last Name:ANTUNEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2320 NORTH BLVD W STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8961
Mailing Address - Country:US
Mailing Address - Phone:305-498-9353
Mailing Address - Fax:
Practice Address - Street 1:2320 NORTH BLVD W STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8961
Practice Address - Country:US
Practice Address - Phone:305-498-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical