Provider Demographics
NPI:1801545660
Name:GUILLAUME, FREDINNA KETIA
Entity type:Individual
Prefix:
First Name:FREDINNA
Middle Name:KETIA
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21943 REMSEN TER APT 206C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7850
Mailing Address - Country:US
Mailing Address - Phone:407-881-4708
Mailing Address - Fax:
Practice Address - Street 1:21943 REMSEN TER APT 206C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7850
Practice Address - Country:US
Practice Address - Phone:407-881-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst