Provider Demographics
NPI:1447804158
Name:GUGLIELMO, DANIEL M (BCBA, OP COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:GUGLIELMO
Suffix:
Gender:M
Credentials:BCBA, OP COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 47TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1108
Mailing Address - Country:US
Mailing Address - Phone:315-335-7114
Mailing Address - Fax:
Practice Address - Street 1:2571 47TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1108
Practice Address - Country:US
Practice Address - Phone:315-335-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
1-21-52140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid