Provider Demographics
NPI:1821166380
Name:URRUTIA, MANUEL ERNESTO (LCSW)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ERNESTO
Last Name:URRUTIA
Suffix:
Gender:M
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:PO BOX 26182
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-6182
Mailing Address - Country:US
Mailing Address - Phone:669-666-0936
Mailing Address - Fax:
Practice Address - Street 1:1877 MONTEREY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-494-5161
Practice Address - Fax:408-292-3640
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 276981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical