Provider Demographics
NPI:1558702845
Name:THIBERGE, DAPHNE (LCSW)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:THIBERGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:
Other - Last Name:ALROY THIBERGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:245 FISHER PL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6443
Mailing Address - Country:US
Mailing Address - Phone:609-250-5141
Mailing Address - Fax:
Practice Address - Street 1:245 FISHER PL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6443
Practice Address - Country:US
Practice Address - Phone:609-250-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057967001041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health