Provider Demographics
NPI:1912332388
Name:GUILLERMO, FLOREN MARY E (MFT-INTERN)
Entity Type:Individual
Prefix:
First Name:FLOREN MARY
Middle Name:E
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:MFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6931 VAN NUYS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3980
Mailing Address - Country:US
Mailing Address - Phone:818-376-0134
Mailing Address - Fax:818-376-1437
Practice Address - Street 1:6931 VAN NUYS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3980
Practice Address - Country:US
Practice Address - Phone:818-376-0134
Practice Address - Fax:818-376-1437
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF67619106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist