Provider Demographics
NPI:1386475382
Name:GUTIERREZ, MARIA FERNANDA (LMSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 DON ST
Mailing Address - Street 2:
Mailing Address - City:KISMET
Mailing Address - State:KS
Mailing Address - Zip Code:67859-9622
Mailing Address - Country:US
Mailing Address - Phone:620-556-9557
Mailing Address - Fax:
Practice Address - Street 1:21 PLAZA DR STE 7
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2791
Practice Address - Country:US
Practice Address - Phone:575-708-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker