Provider Demographics
NPI:1023888773
Name:GUTIERREZ, SILVIA VANESSA (LCSW)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:VANESSA
Last Name:GUTIERREZ
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 1:148 SW 96TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2046
Mailing Address - Country:US
Mailing Address - Phone:786-717-3432
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 660
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3485
Practice Address - Country:US
Practice Address - Phone:305-900-2361
Practice Address - Fax:305-900-2371
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW22377101YM0800X, 1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124556800Medicaid
FL122246700Medicaid