Provider Demographics
NPI:1013528512
Name:GUILAVOGUI, KOLY J (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:KOLY
Middle Name:J
Last Name:GUILAVOGUI
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E 176TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4617
Mailing Address - Country:US
Mailing Address - Phone:718-583-5150
Mailing Address - Fax:718-228-7648
Practice Address - Street 1:770 E 176TH ST STE 315
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4617
Practice Address - Country:US
Practice Address - Phone:718-583-5150
Practice Address - Fax:718-228-7648
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31698-T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)