Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW 9319 | FL |
NPI | 1003068578 |
---|---|
Provider Name | Madeline C Guarino |
First Address | Mary Esther, FL 32569-2059 |
Second Address | Mary Esther, FL 32569-2059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2008 |
Last Update Date | 12/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SW 9319 | LICENSED CLINICAL SOCIAL WORKER (01) | FL |