Provider Demographics
NPI:1508597857
Name:GUTIERREZ, MERCEDES (MSW, ASW # 109251)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSW, ASW # 109251
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:CERON TAPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 CLINTON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1595
Practice Address - Country:US
Practice Address - Phone:650-288-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA1092511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker