Provider Demographics
NPI:1104259399
Name:GUZMAN GUTIERREZ, MARIA JOSEFINA (LCSW,96319)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSEFINA
Last Name:GUZMAN GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW,96319
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W FREMONT AVE UNIT 2074
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-9003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 ELM ST STE 212
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3070
Practice Address - Country:US
Practice Address - Phone:650-591-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA963191041C0700X
101YM0800X, 104100000X, 1041C0700X
CA36579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker