MEDICARE: BETHANY GUGLIANO LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	72639	IA
2	1041C0700X	Clinical Social Worker	072639	IA

General Provider Information

NPI Number	:	1821534728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY GUGLIANO LISW

Provider Business Mailing Address
First Line	:	595 ASHLEY CT STE 1
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4758
Country	:	US
Telephone Number	:	319-626-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 ASHLEY CT STE 1
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4758
Country	:	US
Telephone Number	:	319-626-2224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	04/14/2023

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Directions to “ BETHANY GUGLIANO LISW” Practice Location

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