Provider Demographics
NPI:1477253185
Name:MCGUFFOG, OLIVIA GLENN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:GLENN
Last Name:MCGUFFOG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:GLENN
Other - Last Name:HAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1201 KINGS HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5319
Mailing Address - Country:US
Mailing Address - Phone:203-807-4174
Mailing Address - Fax:
Practice Address - Street 1:1201 KINGS HWY STE 2
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5319
Practice Address - Country:US
Practice Address - Phone:203-807-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional