Provider Demographics
NPI:1225583586
Name:GUTIERREZ, MARY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CHESTNUT ST STE 3E
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5241
Mailing Address - Country:US
Mailing Address - Phone:360-788-6565
Mailing Address - Fax:360-788-6567
Practice Address - Street 1:800 E CHESTNUT ST STE 3E
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5241
Practice Address - Country:US
Practice Address - Phone:360-788-6565
Practice Address - Fax:360-788-6567
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607877721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical