Provider Demographics
NPI:1467939231
Name:SERRANO, ELIZABET GUZMAN
Entity Type:Individual
Prefix:
First Name:ELIZABET
Middle Name:GUZMAN
Last Name:SERRANO
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 1:616 BRIMLEY CT
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-8844
Mailing Address - Country:US
Mailing Address - Phone:561-563-9624
Mailing Address - Fax:
Practice Address - Street 1:616 BRIMLEY CT
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-8844
Practice Address - Country:US
Practice Address - Phone:561-563-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-23-68596103K00000X
FLRBT-17-34530106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018677800Medicaid