| Doctor Name: | CARLOS RUBEN GUTIERREZ |
| NPI Number: | 1518211903 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 08011-1 |
| Business Practice Address: | 350 Martha Ave Bellport, NY - 117131525 |
| Business Phone Number: | 6312866923 |
| Business Fax Number: | |
| Mailing Address: | 6 Montana Ct, CORAM |
| State: | NY |
| Postal Code: | 117271515 |
| Phone Number: | 6315130264 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2012 |
| NPI Last Update Date: | 11/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 08011-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |