Provider Demographics
NPI:1689646747
Name:GUGLIELMINO, MICHAEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GUGLIELMINO
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 1:8 GORDON CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5309
Mailing Address - Country:US
Mailing Address - Phone:973-818-4561
Mailing Address - Fax:973-338-0262
Practice Address - Street 1:8 GORDON CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5309
Practice Address - Country:US
Practice Address - Phone:973-818-4561
Practice Address - Fax:973-338-0262
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004046001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS29325Medicare UPIN
NJ641851Medicare ID - Type Unspecified