Provider Demographics
NPI:1730842279
Name:GUTIERREZ LORENZANA, CRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:GUTIERREZ LORENZANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5200
Mailing Address - Country:US
Mailing Address - Phone:530-752-0871
Mailing Address - Fax:
Practice Address - Street 1:1 SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5200
Practice Address - Country:US
Practice Address - Phone:530-752-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA889101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical