Active NPI
Angela Gutierrez, LCSW
- Clinical Social Worker
- Portage, IN
National Provider Identifier
1699249557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34008103A
- Practice address
- 2428 Sea Horse St
Portage, IN 46368-6509 - Phone
- (219) 841-2316
- NPI assigned
- Jan 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 34008103A | IN | Primary |
Addresses
Primary practice location
2428 Sea Horse St
Portage, IN 46368-6509
Mailing address
2428 Sea Horse St
Portage, IN 46368-6509
Phone (219) 841-2316
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34008103A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547424000000",
"number": "1699249557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2428 SEA HORSE ST",
"city": "PORTAGE",
"state": "IN",
"postal_code": "463686509",
"telephone_number": "219-841-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2428 SEA HORSE ST",
"city": "PORTAGE",
"state": "IN",
"postal_code": "463686509",
"telephone_number": "219-841-2316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "ANGELA",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-14",
"last_updated": "2019-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34008103A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.