Provider Demographics
NPI:1053820936
Name:GUILLEN, ELIZABETH (RBT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 SW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5428
Mailing Address - Country:US
Mailing Address - Phone:786-214-1670
Mailing Address - Fax:
Practice Address - Street 1:3812 SW 89TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5428
Practice Address - Country:US
Practice Address - Phone:786-214-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid