# BRANDON RONALD THIBEAULT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053947028
- **Gender:** Man
- **Credential:** LICSW, LCSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 93042 | CA | — |
| 1041C0700X | Clinical Social Worker | ISW03070 | RI | Yes |

## Other

- **Enumeration date:** 03/21/2020
- **Last updated:** 11/27/2023