Basic Information
| Provider Information | |||||||||
| NPI: | 1679881973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATALLAH-GUTIERREZ | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | GUTIERREZ | ||||||||
| OtherFirstName: | CELESTE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 850 HARRISON AVE | ||||||||
| Address2: | DOWLING 9, CHILD PSYCHIATRY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021184001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
| FaxNumber: | 6174141975 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 HARRISON AVE | ||||||||
| Address2: | DOWLING 9, CHILD PSYCHIATRY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021184001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
| FaxNumber: | 6174141975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2010 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.