Provider Demographics
NPI:1427812320
Name:GUZMAN, WILFREDO ALEXIS
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:ALEXIS
Last Name:GUZMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3841
Mailing Address - Country:US
Mailing Address - Phone:321-800-2922
Mailing Address - Fax:
Practice Address - Street 1:801 N MAGNOLIA AVE STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3841
Practice Address - Country:US
Practice Address - Phone:321-800-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health