MEDICARE: MS. LAURA LINDA GUTIERREZ WOOLRIDGE LCSW LCS 25679

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 25679	CA

General Provider Information

NPI Number	:	1962561175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA LINDA GUTIERREZ WOOLRIDGE LCSW LCS 25679

Provider Business Mailing Address
First Line	:	1000 S HILL RD
Second Line	:	STE 100
City	:	VENTURA
State	:	CA
Zip	:	93003-4455
Country	:	US
Telephone Number	:	805-485-6114
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 MISSION OAKS BLVD
Second Line	:	SUITE I
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5121
Country	:	US
Telephone Number	:	805-485-6114
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/11/2022

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