Basic Information
| Provider Information | |||||||||
| NPI: | 1730467127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | DORA | ||||||||
| MiddleName: | VIVIANA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1745 BROADWAY | ||||||||
| Address2: | 17TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100194640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518101 | ||||||||
| FaxNumber: | 2125370102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1745 BROADWAY | ||||||||
| Address2: | 17TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100194640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518101 | ||||||||
| FaxNumber: | 2125370102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 11/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 013844 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.