MEDICARE: CHADLI GUTIERREZ PSY,D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	RBT-25-475553	FL
2	103T00000X	Psychologist	8738	PR

General Provider Information

NPI Number	:	1457170342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHADLI GUTIERREZ PSY,D

Provider Business Mailing Address
First Line	:	PO BOX 502
Second Line	:
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00977-0502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 CALLE JOSE C. BARBOSA
Second Line	:	SUITE #3
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771
Country	:	US
Telephone Number	:	904-257-3065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	02/18/2026

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