=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083177117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMIE GUTTERMAN LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2019
-----------------------------------------------------
Last Update Date | 04/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E CARR ST
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-358-3412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E CARR ST
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-358-3412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMIE GUTTERMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 919-358-3412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------