Provider Demographics
NPI:1568010163
Name:GAUTHIER, ANTOINETTE PALKA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:PALKA
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LOMB MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5608
Mailing Address - Country:US
Mailing Address - Phone:585-475-2261
Mailing Address - Fax:585-475-6548
Practice Address - Street 1:115 LOMB MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5608
Practice Address - Country:US
Practice Address - Phone:585-475-2261
Practice Address - Fax:585-475-6548
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0834831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical