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Individual
TERESA J. GUTIERREZ
Active
Individual
TERESA J. GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I4202
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000168998
ANTHEM PROV. ID
OH
01
—
0005295036
AETNA PIN
OH
01
—
341891557-001
MED MUT OH PROV. NO.
OH
01
—
V34189155767813
HEALTHPARTNERS VENDOR NO.
OH
Enumeration date
05/23/2005
Last updated
10/17/2007
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