Provider Demographics
NPI:1134576887
Name:CRUZ GUZMAN, MERY (BCBA -1-17-28408)
Entity type:Individual
Prefix:
First Name:MERY
Middle Name:
Last Name:CRUZ GUZMAN
Suffix:
Gender:F
Credentials:BCBA -1-17-28408
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27541 SW 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7775
Mailing Address - Country:US
Mailing Address - Phone:786-712-3844
Mailing Address - Fax:
Practice Address - Street 1:27541 SW 138TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7775
Practice Address - Country:US
Practice Address - Phone:786-712-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA-1-17-28408103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017475100Medicaid
BCBA-1-17-28408OtherBEHAVIOR ANALYST CERTIFICATION BOARD