Provider Demographics
NPI:1497141873
Name:GUGLIELMO, JACLYN A (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:A
Last Name:GUGLIELMO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16482 WHEATLEY CT
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-8903
Mailing Address - Country:US
Mailing Address - Phone:914-438-5731
Mailing Address - Fax:
Practice Address - Street 1:16482 WHEATLEY CT
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-8903
Practice Address - Country:US
Practice Address - Phone:914-438-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000442-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst