Provider Demographics
NPI:1124503073
Name:GUTMANN, RUSSELL CHARLES II (LCSW)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:CHARLES
Last Name:GUTMANN
Suffix:II
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 1:1023 JONES ST APT 706
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2938
Mailing Address - Country:US
Mailing Address - Phone:941-587-5570
Mailing Address - Fax:
Practice Address - Street 1:2235 S 46TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3304
Practice Address - Country:US
Practice Address - Phone:531-299-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48041041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool