Provider Demographics
NPI:1598357105
Name:GUZMAN, MEGHAN (RBT)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 NW 179TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6508
Mailing Address - Country:US
Mailing Address - Phone:786-417-0402
Mailing Address - Fax:
Practice Address - Street 1:8820 NW 179TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6508
Practice Address - Country:US
Practice Address - Phone:786-417-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-21-153173106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician