Provider Demographics
NPI:1700124112
Name:GUERRERO, JAIME (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:GUERRERO
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 1:5111 SE MILES GRANT RD APT 201
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-1827
Mailing Address - Country:US
Mailing Address - Phone:859-489-8155
Mailing Address - Fax:
Practice Address - Street 1:555 COLORADO AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3013
Practice Address - Country:US
Practice Address - Phone:859-489-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9449103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling