Provider Demographics
NPI:1447492640
Name:GUGLIOTTA, DONNA MARIE (MS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:GUGLIOTTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30131 TOWN CENTER DR STE 280
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2086
Mailing Address - Country:US
Mailing Address - Phone:949-295-6994
Mailing Address - Fax:949-495-7686
Practice Address - Street 1:30131 TOWN CENTER DR STE 280
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2086
Practice Address - Country:US
Practice Address - Phone:949-295-6994
Practice Address - Fax:949-495-7686
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health