Provider Demographics
NPI:1255462305
Name:GUTIERREZ, MONICA (LCSW 27803)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW 27803
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 RIVERVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-8949
Mailing Address - Country:US
Mailing Address - Phone:831-524-1918
Mailing Address - Fax:
Practice Address - Street 1:2690 CIENEGA RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-9687
Practice Address - Country:US
Practice Address - Phone:209-737-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical