Provider Demographics
NPI:1598120933
Name:GUTZMER, CHERYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYCE
Middle Name:
Last Name:GUTZMER
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 1:5905 SOQUEL DR STE 650
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2862
Mailing Address - Country:US
Mailing Address - Phone:831-728-5256
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DR STE 650
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2862
Practice Address - Country:US
Practice Address - Phone:831-728-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20287LCS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health