Active NPI
Teresa J. Gutierrez, LISW
- Clinical Social Worker
- Mayfield HTS, OH
National Provider Identifier
1508869504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I4202
- Practice address
- 6009 Landerhaven Dr
Ste F
Mayfield HTS, OH 44124-4192 - Phone
- (440) 646-0671
- Fax
- (440) 461-5033
- NPI assigned
- May 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I4202 | OH | Primary |
Addresses
Primary practice location
6009 Landerhaven Dr
Ste F
Mayfield HTS, OH 44124-4192
Mailing address
6009 Landerhaven Dr
Ste F
Mayfield HTS, OH 44124-4192
Phone (440) 646-0671
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005295036 | Other | OH | AETNA PIN |
| 000000168998 | Other | OH | ANTHEM PROV. ID |
| 341891557-001 | Other | OH | MED MUT OH PROV. NO. |
| V34189155767813 | Other | OH | HEALTHPARTNERS VENDOR NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I4202 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1508869504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6009 LANDERHAVEN DR",
"address_2": "STE F",
"city": "MAYFIELD HTS",
"state": "OH",
"postal_code": "441244192",
"telephone_number": "440-646-0671",
"fax_number": "440-461-5033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6009 LANDERHAVEN DR",
"address_2": "STE F",
"city": "MAYFIELD HTS",
"state": "OH",
"postal_code": "441244192",
"telephone_number": "440-646-0671",
"fax_number": "440-461-5033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "TERESA",
"middle_name": "J.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-05-23",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I4202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN",
"identifier": "0005295036",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROV. ID",
"identifier": "000000168998",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MED MUT OH PROV. NO.",
"identifier": "341891557-001",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS VENDOR NO.",
"identifier": "V34189155767813",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mayfield HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.