| John R Thibodeau Llc | |
|
296 New Waterford Pl Longwood FL 32779-5656 | |
| (321) 972-5693 | |
| (321) 972-5693 |
| Full Name | John R Thibodeau Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 296 New Waterford Pl, Longwood, Florida |
| Authorized Official Name and Position | John R. Thibodeau (SOLE MEMBER) |
| Authorized Official Contact | 3219725693 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John R Thibodeau Llc 296 New Waterford Pl Longwood FL 32779-5656 Ph: (321) 972-5693 | John R Thibodeau Llc 296 New Waterford Pl Longwood FL 32779-5656 Ph: (321) 972-5693 |
| NPI Number | 1417183419 |
|---|---|
| Provider Enumeration Date | 06/04/2009 |
| Last Update Date | 06/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417183419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY 7684 (Florida) | Primary |
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