Provider Demographics
NPI:1467110262
Name:GUTIERREZ, GENELLE M (LCSW)
Entity Type:Individual
Prefix:
First Name:GENELLE
Middle Name:M
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 1:8 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1422
Mailing Address - Country:US
Mailing Address - Phone:201-486-6890
Mailing Address - Fax:
Practice Address - Street 1:8 MORNINGSIDE RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1422
Practice Address - Country:US
Practice Address - Phone:201-486-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060457001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical