Provider Demographics
NPI:1023261807
Name:THIBODEAU, YVETTE M
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:M
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DOWNEY DR
Mailing Address - Street 2:APT D
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-2525
Mailing Address - Country:US
Mailing Address - Phone:860-436-2341
Mailing Address - Fax:
Practice Address - Street 1:19 DOWNEY DRIVE
Practice Address - Street 2:APT D
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-436-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical