Provider Demographics
NPI:1609401090
Name:GAUTHIER, MADELINE LORAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:LORAYE
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:LORAYE
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:50 BROADWAY APT 52
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4446
Mailing Address - Country:US
Mailing Address - Phone:207-332-1874
Mailing Address - Fax:
Practice Address - Street 1:41 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1496
Practice Address - Country:US
Practice Address - Phone:781-756-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223117104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker