MEDICARE: MICHELINA GAUTIERI PSY.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	103T00000X	Psychologist	PSY13458	CA

General Provider Information

NPI Number	:	1841211976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELINA GAUTIERI PSY.D.

Provider Business Mailing Address
First Line	:	131 POPLAR ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-1325
Country	:	US
Telephone Number	:	510-526-4853
Fax Number	:	415-473-3080

Provider Business Practice Location Address
First Line	:	3230 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4840
Country	:	US
Telephone Number	:	415-473-5053
Fax Number	:	415-473-3080

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	06/03/2011

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