MEDICARE: MS. JASMINE GUTIERREZ

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	101YM0800X	Mental Health Counselor	017168-01	NY
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1750882999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE GUTIERREZ

Provider Business Mailing Address
First Line	:	153 E 110TH ST UNIT 143
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-9602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 E 110TH ST UNIT 143
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-9602
Country	:	US
Telephone Number	:	929-900-6145
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/19/2026

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