Provider Demographics
NPI:1104015072
Name:TERESA J GUTIERREZ, LISW, INC.
Entity Type:Organization
Organization Name:TERESA J GUTIERREZ, LISW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-646-0671
Mailing Address - Street 1:6009 LANDERHAVEN DR
Mailing Address - Street 2:STE F
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4192
Mailing Address - Country:US
Mailing Address - Phone:440-646-0671
Mailing Address - Fax:440-641-5033
Practice Address - Street 1:6009 LANDERHAVEN DR
Practice Address - Street 2:STE F
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4192
Practice Address - Country:US
Practice Address - Phone:440-646-0671
Practice Address - Fax:440-641-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI42021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW20601Medicare PIN