Provider Demographics
NPI:1912058090
Name:GUTFELD, KEVIN LOUIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LOUIS
Last Name:GUTFELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W PERKINS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4859
Mailing Address - Country:US
Mailing Address - Phone:707-462-0599
Mailing Address - Fax:707-462-0799
Practice Address - Street 1:216 W PERKINS ST STE 207
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4859
Practice Address - Country:US
Practice Address - Phone:707-462-0599
Practice Address - Fax:707-462-0799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 185231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical