Provider Demographics
NPI:1770647810
Name:GUIDERA, THOMAS F (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:GUIDERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3221
Mailing Address - Country:US
Mailing Address - Phone:321-268-5682
Mailing Address - Fax:321-268-5683
Practice Address - Street 1:1777 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3221
Practice Address - Country:US
Practice Address - Phone:321-268-5682
Practice Address - Fax:321-268-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical