Provider Demographics
NPI:1437758455
Name:GUTMAN, STACEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1432
Mailing Address - Country:US
Mailing Address - Phone:215-527-3799
Mailing Address - Fax:
Practice Address - Street 1:31 CAMBRIDGE LN STE A
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3329
Practice Address - Country:US
Practice Address - Phone:215-968-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health