Healthcare Provider Details

I. General information

NPI: 1245541747
Provider Name (Legal Business Name): MAXINE CANO GUTIERREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S 5TH ST SUITE #122
MCALLEN TX
78503-2927
US

IV. Provider business mailing address

1106 W 3RD ST
WESLACO TX
78596-5608
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-9454
  • Fax: 956-630-9447
Mailing address:
  • Phone: 956-969-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: