Provider Demographics
NPI:1548964711
Name:THIBODEAU, SARAH KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHLEEN
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4435
Mailing Address - Country:US
Mailing Address - Phone:860-770-9276
Mailing Address - Fax:
Practice Address - Street 1:769 NEWFIELD ST STE 8
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1846
Practice Address - Country:US
Practice Address - Phone:860-770-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0119321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical