Provider Demographics
NPI:1164027074
Name:GAUTHIER, LISA (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-3203
Mailing Address - Country:US
Mailing Address - Phone:866-746-1184
Mailing Address - Fax:
Practice Address - Street 1:14 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-3203
Practice Address - Country:US
Practice Address - Phone:866-746-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical