Provider Demographics
NPI:1023199510
Name:GUTMAN, BETTY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-673-3930
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:1424 MADERA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3053
Practice Address - Country:US
Practice Address - Phone:805-522-5722
Practice Address - Fax:805-915-4141
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW745541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023199510OtherBEACON
MT00071662644OtherAETNA
MT70595OtherBCBS
MT40771OtherALLEGIANCE
MTG9718OtherAPS