Provider Demographics
NPI:1447792833
Name:GUGLIELMO, CARLA L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:L
Last Name:GUGLIELMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3443
Mailing Address - Country:US
Mailing Address - Phone:203-574-8150
Mailing Address - Fax:203-574-8154
Practice Address - Street 1:422 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3443
Practice Address - Country:US
Practice Address - Phone:203-574-8150
Practice Address - Fax:203-574-8154
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0030691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical