Provider Demographics
NPI:1477105591
Name:GUTLOVE, TALIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:
Last Name:GUTLOVE
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 1:317 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1108
Mailing Address - Country:US
Mailing Address - Phone:646-491-0276
Mailing Address - Fax:
Practice Address - Street 1:317 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1108
Practice Address - Country:US
Practice Address - Phone:646-491-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0953551041C0700X
NY104045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker