Provider Demographics
NPI:1093899353
Name:GUTMAN, NICOLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1511
Mailing Address - Country:US
Mailing Address - Phone:213-430-6723
Mailing Address - Fax:213-895-6236
Practice Address - Street 1:529 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1511
Practice Address - Country:US
Practice Address - Phone:213-430-6723
Practice Address - Fax:213-895-6236
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20226101YM0800X
CA272171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health