Provider Demographics
NPI:1023392362
Name:GUGLIELMELLI, KELLIE (MA)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:GUGLIELMELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W HALEY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3471
Mailing Address - Country:US
Mailing Address - Phone:805-777-3523
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator