Provider Demographics
NPI:1316445950
Name:GUTIERREZ, SUSANNE ALLISON
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:ALLISON
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:ALLISON
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6831 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3927
Mailing Address - Country:US
Mailing Address - Phone:951-377-5938
Mailing Address - Fax:
Practice Address - Street 1:6831 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3927
Practice Address - Country:US
Practice Address - Phone:951-377-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA658511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical