Provider Demographics
NPI:1841211976
Name:GAUTIERI, MICHELINA (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELINA
Middle Name:
Last Name:GAUTIERI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1325
Mailing Address - Country:US
Mailing Address - Phone:510-526-4853
Mailing Address - Fax:415-473-3080
Practice Address - Street 1:3230 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-5053
Practice Address - Fax:415-473-3080
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13458103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist