Individual
BRANDON RONALD THIBEAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW, LCSW
Contact information
Practice address
20 RUSSELL AVE, NEWPORT, RI 02840-1724
(207) 318-9630
Mailing address
20 RUSSELL AVE, NEWPORT, RI 02840-1724
(207) 318-9630
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
93042
CA
1041C0700X
Clinical Social Worker
Primary
ISW03070
RI
Other
Enumeration date
03/21/2020
Last updated
11/27/2023
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