Provider Demographics
NPI:1336734193
Name:THIBODEAU, KRISTEN BUTTON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:BUTTON
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2226
Mailing Address - Country:US
Mailing Address - Phone:603-560-5199
Mailing Address - Fax:
Practice Address - Street 1:28 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2142
Practice Address - Country:US
Practice Address - Phone:603-432-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical