Provider Demographics
NPI:1841966868
Name:GUERRA CHICO, ADRADYS (BACB686952)
Entity type:Individual
Prefix:
First Name:ADRADYS
Middle Name:
Last Name:GUERRA CHICO
Suffix:
Gender:F
Credentials:BACB686952
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15432 SW 77TH CIRCLE LN APT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1863
Mailing Address - Country:US
Mailing Address - Phone:954-279-7207
Mailing Address - Fax:
Practice Address - Street 1:15432 SW 77TH CIRCLE LN APT 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1863
Practice Address - Country:US
Practice Address - Phone:954-279-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician