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General NPI Number Information
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NPI Number | 1992947436
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Entity Type | Individual
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Provider Name | ELIZABETH JANE GUGLIELMO-SMITH M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 11835 W OLYMPIC BLVD STE. 1090
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City | LOS ANGELES
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State | CA
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Zip | 90064-5001
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Country | US
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Telephone | 310-473-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 3047 HERMOSA AVE
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3710
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Country | US
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Telephone | 818-957-0867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW# 23881
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License Number State | CA
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