Provider Demographics
NPI:1356785174
Name:GUZMAN NEGRETE, CARMEN M (CBHCMS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:GUZMAN NEGRETE
Suffix:
Gender:
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4883 FELLS COVE AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9250
Mailing Address - Country:US
Mailing Address - Phone:407-271-3794
Mailing Address - Fax:321-256-5799
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7593
Practice Address - Country:US
Practice Address - Phone:407-789-6928
Practice Address - Fax:321-256-5799
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100474171M00000X
PR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008560900Medicaid