Provider Demographics
NPI:1184309098
Name:HERNANDEZ CANTALLOPS, GUADALUPE MASSIEL
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MASSIEL
Last Name:HERNANDEZ CANTALLOPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 CRESTMORE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5017
Mailing Address - Country:US
Mailing Address - Phone:239-895-2744
Mailing Address - Fax:
Practice Address - Street 1:6702 N GUNLOCK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4508
Practice Address - Country:US
Practice Address - Phone:813-644-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other