MEDICARE: MS. YESENIA JACQUELINE GUTIERREZ MS.ED

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	106H00000X	Marriage & Family Therapist	MT5137	FL

General Provider Information

NPI Number	:	1700458957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YESENIA JACQUELINE GUTIERREZ MS.ED

Provider Business Mailing Address
First Line	:	13727 SW 152ND ST # 1297
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-1106
Country	:	US
Telephone Number	:	786-564-5988
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 WILLIAMS DR STE 300
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4648
Country	:	US
Telephone Number	:	571-609-3507
Fax Number	:

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

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	10/30/2025

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