MEDICARE: EMTHIBODEAU, LICSW, LLC

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	1328	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1750304218	OTHER	NH	NPI INDIVIDUAL

General Provider Information

NPI Number	:	1265757470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMTHIBODEAU, LICSW, LLC

Provider Business Mailing Address
First Line	:	330 NEW DURHAM RD
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4923
Country	:	US
Telephone Number	:	603-941-4878
Fax Number	:	603-941-0410

Provider Business Practice Location Address
First Line	:	330 NEW DURHAM RD
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4923
Country	:	US
Telephone Number	:	603-941-4878
Fax Number	:	603-941-0410

Authorized Official
Title or Position	:	OWNER
Name	:	ESTELLE M THIBODEAU
Credential	:	LICSW
Telephone Number	:	603-941-4878

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	01/26/2024

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