Provider Demographics
NPI:1396636825
Name:GALLEGO ALVAREZ, JUAN GUILLERMO
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:GUILLERMO
Last Name:GALLEGO ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 CROYDEN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9184
Mailing Address - Country:US
Mailing Address - Phone:407-580-1017
Mailing Address - Fax:
Practice Address - Street 1:11037 CROYDEN WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9184
Practice Address - Country:US
Practice Address - Phone:407-580-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health