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General NPI Number Information
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NPI Number | 1881667582
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Entity Type | Organization
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Legal Business Name | PRINCETON CONSULTING AND THERAPY, LLC
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Dates
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Enumeration Date | 02/12/2006
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Last Update Date | 10/02/2010
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Provider Practice Location Address
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Address Line | 5234 OVERLOOK LN
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9111
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Country | US
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Telephone | 585-331-9320
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Fax |
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Provider Business Mailing Address
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Address Line | 5234 OVERLOOK LN
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9111
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Country | US
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Telephone | 585-331-9320
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. EDWARD JOSEPH THIBODEAU
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Credential | MSSA
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Telephone | 585-331-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04888700
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License Number State | NJ
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