Carla R. Gutierrez Dominguez, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.018983 Issued in IL

Practice address

671 S Lewis Ave
Waukegan, IL 60085-6101

Phone

(847) 782-4156

Fax

(847) 782-1030

NPI assigned

Mar 31, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483401600000",
    "number": "1104289867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "671 S LEWIS AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "671 S LEWIS AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600856101",
            "telephone_number": "847-782-4156",
            "fax_number": "847-782-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ DOMINGUEZ",
        "first_name": "CARLA",
        "middle_name": "R.",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2017-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.018983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sindy Lorena Guerra, BA
• Cinthia Guerrero
• Paige Guibourdanche
• Guillermo Arizona D.D.S PC
• Rajat Gupta, M.D.
• Angela J Gutierrez, PHARMD
• Daniel Guzman
• Gwa Optical LLC
• Alexandria Haag, MS
• Yongbin Christine Hahm, D.D.S

• Clinical Social Worker in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.