Provider Demographics
NPI:1477541522
Name:GUGLIELMO, ROCCO MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:MICHAEL
Last Name:GUGLIELMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RELLA BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-8114
Mailing Address - Country:US
Mailing Address - Phone:845-533-0331
Mailing Address - Fax:845-368-2243
Practice Address - Street 1:400 RELLA BLVD STE 165
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-8114
Practice Address - Country:US
Practice Address - Phone:845-368-2243
Practice Address - Fax:845-368-2243
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO15346-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN12341Medicare ID - Type Unspecified