Provider Demographics
NPI:1124178785
Name:GUTTMAN, EMILY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:GUTTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SHULMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5233
Mailing Address - Country:US
Mailing Address - Phone:203-817-0797
Mailing Address - Fax:
Practice Address - Street 1:360 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5233
Practice Address - Country:US
Practice Address - Phone:203-817-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078376104100000X
CT0085001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045287Medicare PIN