Provider Demographics
NPI:1821977125
Name:THIBODEAU, STACY RAE (DNP, MSN, PMHN-BC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:RAE
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:DNP, MSN, PMHN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1928
Mailing Address - Country:US
Mailing Address - Phone:207-999-1157
Mailing Address - Fax:
Practice Address - Street 1:1048 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1232
Practice Address - Country:US
Practice Address - Phone:207-659-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP251559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health