Provider Demographics
NPI:1578060406
Name:GUERRA MAYEDO, GEIDY (BCBA)
Entity type:Individual
Prefix:MS
First Name:GEIDY
Middle Name:
Last Name:GUERRA MAYEDO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 SW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8521
Mailing Address - Country:US
Mailing Address - Phone:786-515-7480
Mailing Address - Fax:
Practice Address - Street 1:8200 NW 41ST ST STE 262
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6205
Practice Address - Country:US
Practice Address - Phone:786-515-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-53447103K00000X
FL0-20-11294106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021693700Medicaid