Provider Demographics
NPI:1972256030
Name:GUTIERREZ, MARIA EUGENIA (RCSWI)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:EUGENIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4610
Mailing Address - Country:US
Mailing Address - Phone:772-766-1396
Mailing Address - Fax:
Practice Address - Street 1:1325 E 24TH ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4610
Practice Address - Country:US
Practice Address - Phone:772-766-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL143601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical