Provider Demographics
NPI:1669762936
Name:GUTNICK, MOISHE ZALMAN (MFT)
Entity type:Individual
Prefix:MR
First Name:MOISHE
Middle Name:ZALMAN
Last Name:GUTNICK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35132
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0132
Mailing Address - Country:US
Mailing Address - Phone:818-268-1721
Mailing Address - Fax:
Practice Address - Street 1:9025 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE SUIT
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1831
Practice Address - Country:US
Practice Address - Phone:310-286-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist