Provider Demographics
NPI:1184883621
Name:GUAGLIANONE, PHILIP (MA)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:GUAGLIANONE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3653
Mailing Address - Country:US
Mailing Address - Phone:310-337-7417
Mailing Address - Fax:
Practice Address - Street 1:7732 ROMAINE ST
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6204
Practice Address - Country:US
Practice Address - Phone:323-656-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist