Healthcare Provider Details

I. General information

NPI: 1609606938
Provider Name (Legal Business Name): EMILY GAUTHIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARTWELL ST # SR
FALL RIVER MA
02721-3019
US

IV. Provider business mailing address

2 HILL ST UNIT 1
SMITHFIELD RI
02917-4004
US

V. Phone/Fax

Practice location:
  • Phone: 401-626-9964
  • Fax:
Mailing address:
  • Phone: 401-626-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW03486
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: