Provider Demographics
NPI:1265757470
Name:EMTHIBODEAU, LICSW, LLC
Entity type:Organization
Organization Name:EMTHIBODEAU, LICSW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-941-4878
Mailing Address - Street 1:330 NEW DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-4923
Mailing Address - Country:US
Mailing Address - Phone:603-941-4878
Mailing Address - Fax:603-941-0410
Practice Address - Street 1:330 NEW DURHAM RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-4923
Practice Address - Country:US
Practice Address - Phone:603-941-4878
Practice Address - Fax:603-941-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424430Medicaid
NH1750304218OtherNPI INDIVIDUAL