Healthcare Provider Details

I. General information

NPI: 1265718159
Provider Name (Legal Business Name): GABRIELLE MARIE GUGLIELMOTTI BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 E GRAND RIVER AVE
HOWELL MI
48843-8503
US

IV. Provider business mailing address

2280 EAST GRAND RIVER AVE
HOWELL MI
48843-7380
US

V. Phone/Fax

Practice location:
  • Phone: 517-546-4126
  • Fax:
Mailing address:
  • Phone: 517-546-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: