Provider Demographics
NPI:1669518460
Name:GUILLORN, ALBERT WILLIAM (LMFT)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:WILLIAM
Last Name:GUILLORN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5532
Mailing Address - Country:US
Mailing Address - Phone:860-584-8336
Mailing Address - Fax:
Practice Address - Street 1:100 FAIR ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5532
Practice Address - Country:US
Practice Address - Phone:860-584-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist