Healthcare Provider Details

I. General information

NPI: 1881807139
Provider Name (Legal Business Name): ROBERT J. GUGLIELMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WOODS LN
BAYVILLE NY
11709-2607
US

IV. Provider business mailing address

7 WOODS LN
BAYVILLE NY
11709-2607
US

V. Phone/Fax

Practice location:
  • Phone: 917-848-6023
  • Fax:
Mailing address:
  • Phone: 917-848-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031791-1
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT JOSEPH GUGLIELMO
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 917-848-6023