Provider Demographics
NPI:1508296260
Name:GUILLERMO, DEBORAH (APSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2934
Mailing Address - Country:US
Mailing Address - Phone:414-324-7362
Mailing Address - Fax:
Practice Address - Street 1:3801 N 82ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2934
Practice Address - Country:US
Practice Address - Phone:414-324-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128517-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical