Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 116643 | MA |
NPI | 1003181439 |
---|---|
Provider Name | Renee Lee Gauthier |
First Address | Gloucester, MA 01930-2259 |
Second Address | Gloucester, MA 01930-2259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 19/03/2012 |