Individual provider Active NPI

Mari Lynn Scarlett Gutierrez, LCSW

  • Clinical Social Worker
  • Ruidoso, NM
National Provider Identifier
1831501147
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C-10849 Issued in NM
Practice address
1096 Mechem Dr Ste 213
Ruidoso, NM 88345-7068
Phone
(575) 223-8184
NPI assigned
May 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X M-09838 NM
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X C-10849 NM Primary

Addresses

Primary practice location

1096 Mechem Dr Ste 213
Ruidoso, NM 88345-7068

Mailing address

1096 Mechem Dr Ste 213
Ruidoso, NM 88345-7068
Phone (752) 233-8184

Other identifiers 1

IdentifierTypeStateIssuer
95636757MedicaidNM

Other names 1

  • Mari Lynn Reikow Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191016000319 NM Practitioner - Clinical Social Worker 1850622291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mental Health Stop LLCGroup PAC ID 9032440474, 2 clinicians

Practice addresses (Care Compare)

1096 Mechem Dr
Suite 213
Ruidoso, NM 88345-7068
Phone (575) 223-8184

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
M-09838NMMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Stop LLC Clinical CurrentSince Sep 4, 2019 Accepting new patients

Locations

1096 Mechem Dr
Ste 213
Ruidoso, NM 88345
Phone (575) 223-8184

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1831501147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 MECHEM DR STE 213",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457068",
            "telephone_number": "752-233-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1096 MECHEM DR STE 213",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457068",
            "telephone_number": "575-223-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "MARI LYNN",
        "middle_name": "SCARLETT",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-21",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "M-09838",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-10849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95636757",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARI LYNN",
            "last_name": "REIKOW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ruidoso, NM

Sources for this page

Verify at the official NPI Registry.