Provider Demographics
NPI:1386142297
Name:GUTOWSKI, STANLEY JOSEPH
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOSEPH
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1510
Mailing Address - Country:US
Mailing Address - Phone:978-443-1494
Mailing Address - Fax:
Practice Address - Street 1:13 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1510
Practice Address - Country:US
Practice Address - Phone:978-443-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical