Individual provider Active NPI

Peter A Guglielmo, LCSW LADC

  • Clinical Social Worker
  • Stamford, CT
National Provider Identifier
1265513626
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
005589 Issued in CT
Practice address
979 Summer St
Stamford, CT 06905-5550
Phone
(201) 968-6033
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 005589 CT Primary

Addresses

Primary practice location

979 Summer St
Stamford, CT 06905-5550

Mailing address

44 Knickerbocker Rd
Cresskill, NJ 07626-2416
Phone (201) 968-6033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040729001162 CT Practitioner - Clinical Social Worker 1355311986 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5589CTMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Jun 18, 2016 Accepting new patients
State of Connecticut CurrentSince Jun 18, 2016 Accepting new patients

Locations

1635 Central Ave
Bridgeport, CT 06610
Phone (203) 551-7464

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1265513626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 KNICKERBOCKER RD",
            "city": "CRESSKILL",
            "state": "NJ",
            "postal_code": "076262416",
            "telephone_number": "201-968-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "979 SUMMER ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055550",
            "telephone_number": "201-968-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUGLIELMO",
        "first_name": "PETER",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "LCSW LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

Verify at the official NPI Registry.