Individual provider Active NPI

Rocco Michael Guglielmo, LCSW

  • Clinical Social Worker
  • Suffern, NY
National Provider Identifier
1477541522
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
PRO15346-1 Issued in NY
Practice address
400 Rella Blvd Ste 165
Suffern, NY 10901-8114
Phone
(845) 368-2243
Fax
(845) 368-2243
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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 PRO15346-1 NY Primary

Addresses

Primary practice location

400 Rella Blvd Ste 165
Suffern, NY 10901-8114

Mailing address

400 Rella Blvd Ste 165
Suffern, NY 10901-8114
Phone (845) 533-0331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050822001454 NY Practitioner - Clinical Social Worker 3072544840 Practice locations: Suffern, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

400 Rella Blvd
Suite 165
Suffern, NY 10901-8114
Phone (845) 533-0331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PRO15346-1NYMDClinical Social Worker
015346NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1477541522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RELLA BLVD STE 165",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109018114",
            "telephone_number": "845-533-0331",
            "fax_number": "845-368-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RELLA BLVD STE 165",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109018114",
            "telephone_number": "845-368-2243",
            "fax_number": "845-368-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUGLIELMO",
        "first_name": "ROCCO",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2021-04-20",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PRO15346-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffern, NY

Sources for this page

Verify at the official NPI Registry.