Provider Demographics
NPI:1275427247
Name:GUTIERREZ DELEON, DAYRA FLORIDALMA
Entity type:Individual
Prefix:
First Name:DAYRA
Middle Name:FLORIDALMA
Last Name:GUTIERREZ DELEON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 SCR 30
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119-5932
Mailing Address - Country:US
Mailing Address - Phone:601-470-8005
Mailing Address - Fax:
Practice Address - Street 1:1019 SCR 30
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119-5932
Practice Address - Country:US
Practice Address - Phone:601-470-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker