Healthcare Provider Details

I. General information

NPI: 1497668495
Provider Name (Legal Business Name): KATRINA GAUTHIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HAMILTON ST
NEWTON NJ
07860-1804
US

IV. Provider business mailing address

22 HAMILTON ST
NEWTON NJ
07860-1804
US

V. Phone/Fax

Practice location:
  • Phone: 609-579-9869
  • Fax:
Mailing address:
  • Phone: 609-579-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16LA00003600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01307600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: