Provider Demographics
NPI:1205972874
Name:GRAMUGLIA, JOHN CARMELO (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARMELO
Last Name:GRAMUGLIA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-0250
Mailing Address - Country:US
Mailing Address - Phone:603-237-4678
Mailing Address - Fax:
Practice Address - Street 1:4 TITUS HILL RD
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576
Practice Address - Country:US
Practice Address - Phone:603-237-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1342101YA0400X
NH0507101YA0400X
MA1115851041C0700X
NH11961041C0700X
VT089-00009831041C0700X
NJSL 503671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH304276609Medicaid