Healthcare Provider Details

I. General information

NPI: 1104259399
Provider Name (Legal Business Name): MARIA JOSEFINA GUZMAN GUTIERREZ LCSW,96319
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 ELM ST STE 212
SAN CARLOS CA
94070-3070
US

IV. Provider business mailing address

526 W FREMONT AVE UNIT 2074
SUNNYVALE CA
94087-9003
US

V. Phone/Fax

Practice location:
  • Phone: 650-591-9623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: