Provider Demographics
NPI:1710361100
Name:GAUTREAU, JAMIE
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:GAUTREAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOYER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1109
Mailing Address - Country:US
Mailing Address - Phone:914-260-9540
Mailing Address - Fax:
Practice Address - Street 1:10 DOYER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1109
Practice Address - Country:US
Practice Address - Phone:914-260-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency