Healthcare Provider Details

I. General information

NPI: 1689722332
Provider Name (Legal Business Name): KIMBERLY STASNY-GUTERMAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FEDERAL WAY STE 2
GROVELAND MA
01834-1567
US

IV. Provider business mailing address

8 FEDERAL WAY STE 2
GROVELAND MA
01834-1567
US

V. Phone/Fax

Practice location:
  • Phone: 857-201-0293
  • Fax:
Mailing address:
  • Phone: 857-201-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116651
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: