Provider Demographics
NPI:1316445950
Name:GUTIERREZ, SUSANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1740 PLUM LN STE B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-0109
Mailing Address - Country:US
Mailing Address - Phone:909-557-6574
Mailing Address - Fax:909-363-9202
Practice Address - Street 1:1740 PLUM LN STE B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0109
Practice Address - Country:US
Practice Address - Phone:909-557-6574
Practice Address - Fax:909-363-9202
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA658511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical