Healthcare Provider Details

I. General information

NPI: 1518873231
Provider Name (Legal Business Name): THOMAS GUILIANO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MOUNTAIN VIEW AVENUE
LAGUNITAS CA
94938
US

IV. Provider business mailing address

125 MOUNTAIN VIEW AVENUE
LAGUNITAS CA
94938
US

V. Phone/Fax

Practice location:
  • Phone: 973-970-4898
  • Fax:
Mailing address:
  • Phone: 973-970-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: