Healthcare Provider Details

I. General information

NPI: 1881667582
Provider Name (Legal Business Name): PRINCETON CONSULTING AND THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5234 OVERLOOK LN
CANANDAIGUA NY
14424-9111
US

IV. Provider business mailing address

5234 OVERLOOK LN
CANANDAIGUA NY
14424-9111
US

V. Phone/Fax

Practice location:
  • Phone: 585-331-9320
  • Fax:
Mailing address:
  • Phone: 585-331-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04888700
License Number StateNJ

VIII. Authorized Official

Name: MR. EDWARD JOSEPH THIBODEAU
Title or Position: PARTNER
Credential: MSSA
Phone: 585-331-9320