Provider Demographics
NPI:1952882011
Name:GAUTHIER, JOHN LOUIS (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3508
Mailing Address - Country:US
Mailing Address - Phone:413-885-0954
Mailing Address - Fax:
Practice Address - Street 1:6 COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3508
Practice Address - Country:US
Practice Address - Phone:413-885-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105162104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker