Healthcare Provider Details

I. General information

NPI: 1699899013
Provider Name (Legal Business Name): CARRIE L GUTHRIE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY #4300
BERKELEY CA
94720
US

IV. Provider business mailing address

2222 BANCROFT WAY #4300
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-9334
  • Fax:
Mailing address:
  • Phone: 510-847-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW20626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: