Provider Demographics
NPI:1124586821
Name:GUTIERREZ, ANGELA LEIGH (MSW, ASW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEIGH
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 W FIGARDEN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6051
Mailing Address - Country:US
Mailing Address - Phone:559-652-1350
Mailing Address - Fax:
Practice Address - Street 1:4205 W FIGARDEN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6051
Practice Address - Country:US
Practice Address - Phone:559-221-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X, 101Y00000X, 171M00000X
CAASW106541101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor