Provider Demographics
NPI:1508285420
Name:GAUTREAUX, LAQUIZ (MED)
Entity Type:Individual
Prefix:
First Name:LAQUIZ
Middle Name:
Last Name:GAUTREAUX
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LAQUIZ
Other - Middle Name:N
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MASON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2260
Mailing Address - Country:US
Mailing Address - Phone:978-745-2440
Mailing Address - Fax:978-744-1701
Practice Address - Street 1:41 MASON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2260
Practice Address - Country:US
Practice Address - Phone:978-745-2440
Practice Address - Fax:978-744-1701
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health