Provider Demographics
NPI:1750762787
Name:GUTIERREZ-TESKE, GLADYS MARGARITA (LCSW)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:MARGARITA
Last Name:GUTIERREZ-TESKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:MARGARITA
Other - Last Name:TESKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1550 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-270-2100
Mailing Address - Fax:949-650-6976
Practice Address - Street 1:1550 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-270-2100
Practice Address - Fax:949-650-6976
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALICS#210081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical