Provider Demographics
NPI:1285795039
Name:GAUTIER, ANGELA RENEE (MS LMHC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENEE
Last Name:GAUTIER
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MIDDLESEX AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2773
Mailing Address - Country:US
Mailing Address - Phone:978-685-9889
Mailing Address - Fax:978-685-5695
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2773
Practice Address - Country:US
Practice Address - Phone:978-685-9889
Practice Address - Fax:978-685-5695
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18633OtherBC BC
MA703136Medicaid
MA1303287OtherMBHP
MA1303287Medicaid
MANP01332OtherBMC
MA042611055OtherTAX ID
MA1303287Medicaid
MANP01332OtherBMC