Individual
JOHN THIBODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1011 FOREST AVE, PORTLAND, ME 04103-3304
(207) 553-2069
Mailing address
30 PARK ST, #2, PORTLAND, ME 04101-4515
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC10575
ME
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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