Provider Demographics
NPI:1316400013
Name:GUGLIEMOTTO, CETA (LCDC III)
Entity Type:Individual
Prefix:
First Name:CETA
Middle Name:
Last Name:GUGLIEMOTTO
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 REYNOLDSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9334
Mailing Address - Country:US
Mailing Address - Phone:614-307-3983
Mailing Address - Fax:
Practice Address - Street 1:895 PARSONS AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2398
Practice Address - Country:US
Practice Address - Phone:614-434-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161444101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)