Provider Demographics
NPI:1679778906
Name:GAUTIER, RUTH N (BA,LCADC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:N
Last Name:GAUTIER
Suffix:
Gender:F
Credentials:BA,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY RD BLDG 3 SUITE 42
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1681
Mailing Address - Country:US
Mailing Address - Phone:732-264-4360
Mailing Address - Fax:732-264-8655
Practice Address - Street 1:1 BETHANY RD BLDG 3 SUITE 42
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1681
Practice Address - Country:US
Practice Address - Phone:732-264-4360
Practice Address - Fax:732-264-8655
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00055800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)