MEDICARE: STEPHANIE THIBAULT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	16048	CT

General Provider Information

NPI Number	:	1033075734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE THIBAULT LCSW

Provider Business Mailing Address
First Line	:	7 BONNIEVIEW DR
Second Line	:
City	:	EAST GRANBY
State	:	CT
Zip	:	06026-9702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 WATER ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-5339
Country	:	US
Telephone Number	:	203-558-3975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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Directions to “ STEPHANIE THIBAULT LCSW” Practice Location

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