Healthcare Provider Details

I. General information

NPI: 1154593598
Provider Name (Legal Business Name): ADRIANA LUCIA GUTIERREZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 04/18/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DRIVE
SAN HOUSTON TX
78234
US

IV. Provider business mailing address

45 MERRIMACK ST STE. 502
LOWELL MA
01852-1729
US

V. Phone/Fax

Practice location:
  • Phone: 210-439-9391
  • Fax:
Mailing address:
  • Phone: 978-452-7038
  • Fax: 978-452-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number8213
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY8213
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: