Provider Demographics
NPI:1427739242
Name:GUTIERREZ CABRERA, ITZEL RUBI (LMSW)
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:RUBI
Last Name:GUTIERREZ CABRERA
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 1:1900 ATRISCO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1146
Mailing Address - Country:US
Mailing Address - Phone:505-839-4971
Mailing Address - Fax:
Practice Address - Street 1:1900 ATRISCO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1146
Practice Address - Country:US
Practice Address - Phone:505-839-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
NMSWB-2023-04791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool