Provider Demographics
NPI:1275673543
Name:GUTIERREZ, NINNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:NINNETTE
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 1:1441 HUNTINGTON DR # 161
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4512
Mailing Address - Country:US
Mailing Address - Phone:310-997-2697
Mailing Address - Fax:
Practice Address - Street 1:1136 FREMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3249
Practice Address - Country:US
Practice Address - Phone:310-997-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 237931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical