Provider Demographics
NPI:1023864477
Name:GUTIERREZ, JAIMIE (LMHC-A)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PHENIX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-4313
Mailing Address - Country:US
Mailing Address - Phone:954-999-3429
Mailing Address - Fax:
Practice Address - Street 1:1052 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3225
Practice Address - Country:US
Practice Address - Phone:401-461-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMCH00060-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health