Provider Demographics
NPI:1932412160
Name:GUERON, ORLY (MSED)
Entity Type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:GUERON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 NE 191ST ST STE 703
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3117
Mailing Address - Country:US
Mailing Address - Phone:305-924-6555
Mailing Address - Fax:
Practice Address - Street 1:3520 MAGELLAN CIR APT 736
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3760
Practice Address - Country:US
Practice Address - Phone:305-792-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist