Provider Demographics
NPI:1952997785
Name:THIBODEAU, PAUL ANDREW (MS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:THIBODEAU
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NURSERY LN
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3576
Mailing Address - Country:US
Mailing Address - Phone:978-785-5305
Mailing Address - Fax:
Practice Address - Street 1:49 NURSERY LN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3576
Practice Address - Country:US
Practice Address - Phone:978-785-5305
Practice Address - Fax:978-829-0165
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health