Healthcare Provider Details

I. General information

NPI: 1457170342
Provider Name (Legal Business Name): CHADLI GUTIERREZ PSY,D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CALLE JOSE C. BARBOSA SUITE #3
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 502
TRUJILLO ALTO PR
00977-0502
US

V. Phone/Fax

Practice location:
  • Phone: 904-257-3065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8738
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-475553
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: