Provider Demographics
NPI:1568835650
Name:LYCIA ALEXANDER-GUERRA
Entity Type:Organization
Organization Name:LYCIA ALEXANDER-GUERRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LYCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALEXANDER-GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-908-5080
Mailing Address - Street 1:13919 CARROLLWOOD VILLAGE RUN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2746
Mailing Address - Country:US
Mailing Address - Phone:813-908-5080
Mailing Address - Fax:813-908-5081
Practice Address - Street 1:13919 CARROLLWOOD VILLAGE RUN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2746
Practice Address - Country:US
Practice Address - Phone:813-908-5080
Practice Address - Fax:813-908-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45611102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE