MEDICARE: JEFFREY T. GUTERMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 2183	FL

General Provider Information

NPI Number	:	1316153471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY T. GUTERMAN PH.D.

Provider Business Mailing Address
First Line	:	910 WEST AVE
Second Line	:	1526
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5234
Country	:	US
Telephone Number	:	305-725-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 WEST AVE
Second Line	:	1526
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5234
Country	:	US
Telephone Number	:	305-725-4583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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