Provider Demographics
NPI:1083743785
Name:GUTTERMAN, PETER W (MFT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:W
Last Name:GUTTERMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 COLUSA ST
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1501
Mailing Address - Country:US
Mailing Address - Phone:510-851-2789
Mailing Address - Fax:
Practice Address - Street 1:4283 PIEDMONT AVE
Practice Address - Street 2:#E6
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4758
Practice Address - Country:US
Practice Address - Phone:510-496-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist