Provider Demographics
NPI:1750304218
Name:THIBODEAU, ESTELLE M (LICSW)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:M
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1750304218OtherNPI
NH30424430Medicaid
NH30424430Medicaid