Provider Demographics
NPI:1780365312
Name:LADOUCEUR, GUERLINE
Entity type:Individual
Prefix:MRS
First Name:GUERLINE
Middle Name:
Last Name:LADOUCEUR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GUERLINE
Other - Middle Name:
Other - Last Name:LADOUCEUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:825 NW 130TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6540
Mailing Address - Country:US
Mailing Address - Phone:347-938-9933
Mailing Address - Fax:
Practice Address - Street 1:440 SAWGRASS CORPORATE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325-6236
Practice Address - Country:US
Practice Address - Phone:954-745-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician