MEDICARE: MR. JOHN JOSEPH GULINO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149002912	IL

General Provider Information

NPI Number	:	1578547527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JOSEPH GULINO LCSW

Provider Business Mailing Address
First Line	:	1833 HICKS ROAD
Second Line	:	SUITE A
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1247
Country	:	US
Telephone Number	:	847-358-0707
Fax Number	:	847-854-5528

Provider Business Practice Location Address
First Line	:	415 W GOLF RD
Second Line	:	SUITE 4
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3923
Country	:	US
Telephone Number	:	847-806-0707
Fax Number	:	847-854-5528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	12/08/2011

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