Provider Demographics
NPI:1699101758
Name:GUERRA, ASHLEY AMANDA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:AMANDA
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 ROUGHBEARD RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4519
Mailing Address - Country:US
Mailing Address - Phone:407-754-8990
Mailing Address - Fax:
Practice Address - Street 1:1461 S LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7601
Practice Address - Country:US
Practice Address - Phone:407-886-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW136691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106341800Medicaid