Provider Demographics
NPI:1194473876
Name:GUTIERREZ, ALEJANDRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEJANDRA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 S MASSASOIT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3740
Mailing Address - Country:US
Mailing Address - Phone:773-808-8763
Mailing Address - Fax:
Practice Address - Street 1:5747 S MASSASOIT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-3740
Practice Address - Country:US
Practice Address - Phone:773-808-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0186431041C0700X
CA832551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical