Provider Demographics
NPI:1851436562
Name:THIBADEAU, SUSAN FRANCES (PHD BCBA)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FRANCES
Last Name:THIBADEAU
Suffix:
Gender:F
Credentials:PHD BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 EVELYNS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645
Mailing Address - Country:US
Mailing Address - Phone:508-240-0608
Mailing Address - Fax:
Practice Address - Street 1:100 SEA VIEW STREET
Practice Address - Street 2:THE MAY CENTER
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633
Practice Address - Country:US
Practice Address - Phone:508-945-1147
Practice Address - Fax:508-945-2698
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4406103T00000X
MEPS1097103T00000X
1031075103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist