Healthcare Provider Details

I. General information

NPI: 1215490297
Provider Name (Legal Business Name): SARA NICOLE MORAN-GUTIERREZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29850 N VARNUM RD
SAN TAN VALLEY AZ
85143-7064
US

IV. Provider business mailing address

841 E ANASTASIA ST
SAN TAN VALLEY AZ
85140-5790
US

V. Phone/Fax

Practice location:
  • Phone: 909-772-3997
  • Fax:
Mailing address:
  • Phone: 909-772-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: