MEDICARE: MS. VICTORIA MARIA GUTIERREZ-KOVNER L.C.S.W.

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	1041C0700X	Clinical Social Worker	LCS 14687	CA

General Provider Information

NPI Number	:	1700891124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA MARIA GUTIERREZ-KOVNER L.C.S.W.

Provider Business Mailing Address
First Line	:	595 E COLORADO BLVD
Second Line	:	710
City	:	PASADENA
State	:	CA
Zip	:	91101-2039
Country	:	US
Telephone Number	:	818-957-4808
Fax Number	:	818-957-4808

Provider Business Practice Location Address
First Line	:	595 E COLORADO BLVD
Second Line	:	710
City	:	PASADENA
State	:	CA
Zip	:	91101-2039
Country	:	US
Telephone Number	:	818-957-4808
Fax Number	:	818-957-4808

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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