Provider Demographics
NPI:1073072518
Name:ESTRELLA GUZMAN, LUZ DIVINA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:DIVINA
Last Name:ESTRELLA GUZMAN
Suffix:
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 1:890 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4429
Mailing Address - Country:US
Mailing Address - Phone:240-412-5678
Mailing Address - Fax:
Practice Address - Street 1:890 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4429
Practice Address - Country:US
Practice Address - Phone:240-412-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW155961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical