Provider Demographics
NPI:1285273268
Name:GAUTHIER, STEPHEN D (MS, BCBA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3740
Mailing Address - Country:US
Mailing Address - Phone:508-617-8396
Mailing Address - Fax:
Practice Address - Street 1:1573 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3740
Practice Address - Country:US
Practice Address - Phone:508-617-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst