Provider Demographics
NPI:1215490297
Name:MORAN-GUTIERREZ, SARA NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:MORAN-GUTIERREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 E ANASTASIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5790
Mailing Address - Country:US
Mailing Address - Phone:909-772-3997
Mailing Address - Fax:
Practice Address - Street 1:29850 N VARNUM RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-7064
Practice Address - Country:US
Practice Address - Phone:909-772-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
AZ1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMSW-22657OtherARIZONA BOARD OF BEHAVIORAL HEALTH