Provider Demographics
NPI:1790928281
Name:GUERRERO, JOHANNA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:W
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 NW 97TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1850
Mailing Address - Country:US
Mailing Address - Phone:817-707-6307
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6338
Practice Address - Country:US
Practice Address - Phone:305-456-4147
Practice Address - Fax:305-381-5292
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33487103TC0700X
171M00000X
FLPY 8056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021294400Medicaid