Provider Demographics
NPI:1194232017
Name:HERASME, GUILLERMINA I
Entity type:Individual
Prefix:
First Name:GUILLERMINA
Middle Name:
Last Name:HERASME
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 SW 128TH PSGE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5317
Mailing Address - Country:US
Mailing Address - Phone:561-285-7864
Mailing Address - Fax:
Practice Address - Street 1:13316 SW 128TH PSGE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5317
Practice Address - Country:US
Practice Address - Phone:561-285-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst