Provider Demographics
NPI:1811245277
Name:GUGLIANO, AMANDA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:GUGLIANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 W GOVERNMENT ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1490 W GOVERNMENT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3024
Practice Address - Country:US
Practice Address - Phone:601-351-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS50875103TC0700X
NC4243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical