Healthcare Provider Details

I. General information

NPI: 1205972874
Provider Name (Legal Business Name): JOHN CARMELO GRAMUGLIA LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TITUS HILL RD
COLEBROOK NH
03576
US

IV. Provider business mailing address

PO BOX 250
COLEBROOK NH
03576-0250
US

V. Phone/Fax

Practice location:
  • Phone: 603-237-8848
  • Fax:
Mailing address:
  • Phone: 603-237-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1342
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0507
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111585
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1196
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000983
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSL 50367
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: