Provider Demographics
NPI:1386942514
Name:GUTIERREZ, MARIED
Entity type:Individual
Prefix:
First Name:MARIED
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7128
Mailing Address - Country:US
Mailing Address - Phone:407-360-7601
Mailing Address - Fax:
Practice Address - Street 1:125 S SWOOPE AVE STE 201B
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5784
Practice Address - Country:US
Practice Address - Phone:407-360-7601
Practice Address - Fax:407-264-8960
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health