Provider Demographics
NPI:1750102455
Name:GUTERMA, ANNELIE ELLA MARTHA (PHD)
Entity type:Individual
Prefix:
First Name:ANNELIE
Middle Name:ELLA MARTHA
Last Name:GUTERMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNELIE
Other - Middle Name:ELLA MARTHA
Other - Last Name:SIEMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1102 RUGBY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 RUGBY ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1610
Practice Address - Country:US
Practice Address - Phone:631-526-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060159021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical