Provider Demographics
NPI:1053083899
Name:GAUTHIER, RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3330 OLD GLENVIEW RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2963
Mailing Address - Country:US
Mailing Address - Phone:847-920-7920
Mailing Address - Fax:
Practice Address - Street 1:3330 OLD GLENVIEW RD STE 9
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-920-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2025-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0261101041C0700X
IL150.105130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker