Provider Demographics
NPI:1376202002
Name:GUTIERREZ, ANGELA IVANNA (MA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:IVANNA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2415
Mailing Address - Country:US
Mailing Address - Phone:413-231-0248
Mailing Address - Fax:
Practice Address - Street 1:43 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2415
Practice Address - Country:US
Practice Address - Phone:413-231-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health