Provider Demographics
NPI:1013048230
Name:GUGLIELMO, MICHAEL NICHOLAS (NCC LCPC PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:GUGLIELMO
Suffix:
Gender:M
Credentials:NCC LCPC PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45100 ROUTE 59
Mailing Address - Street 2:UNIT 67
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-416-8289
Mailing Address - Fax:630-416-8306
Practice Address - Street 1:45100 ROUTE 59
Practice Address - Street 2:UNIT 67
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-416-8289
Practice Address - Fax:630-416-8306
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42850101Y00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2237367OtherCIGNA
538287OtherVALUE OPTIONS
9146801OtherPHCS
609000OtherPSYCHEALTH GROUP #
4532105OtherBLUE CROSS BLUE SHIELD GR