Provider Demographics
NPI:1881667582
Name:PRINCETON CONSULTING AND THERAPY, LLC
Entity Type:Organization
Organization Name:PRINCETON CONSULTING AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA
Authorized Official - Phone:585-331-9320
Mailing Address - Street 1:5234 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9111
Mailing Address - Country:US
Mailing Address - Phone:585-331-9320
Mailing Address - Fax:
Practice Address - Street 1:5234 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9111
Practice Address - Country:US
Practice Address - Phone:585-331-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-12
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048887001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty