Provider Demographics
NPI:1912318775
Name:GUILLIOT, ROSEMARIE (IMFT)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:GUILLIOT
Suffix:
Gender:F
Credentials:IMFT
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 7856
Mailing Address - Street 2:
Mailing Address - City:AGAT
Mailing Address - State:GU
Mailing Address - Zip Code:96928-0856
Mailing Address - Country:US
Mailing Address - Phone:671-685-5038
Mailing Address - Fax:
Practice Address - Street 1:414 W SOLEDAD AVE
Practice Address - Street 2:GCIC BLDG
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5061
Practice Address - Country:US
Practice Address - Phone:671-685-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF-132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist