Provider Demographics
NPI:1962803148
Name:GUTMAN, VIRGINIA SMITH (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:SMITH
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2037 DIAMOND ST APT B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2213
Practice Address - Country:US
Practice Address - Phone:518-435-9931
Practice Address - Fax:518-459-3715
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087728104100000X
CA910841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker