Brandon Ronald Thibeault, LICSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW03070 Issued in RI

Practice address

20 Russell Ave
Newport, RI 02840-1724

Phone

(207) 318-9630

NPI assigned

Mar 21, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1053947028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 RUSSELL AVE",
            "city": "NEWPORT",
            "state": "RI",
            "postal_code": "028401724",
            "telephone_number": "207-318-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 RUSSELL AVE",
            "city": "NEWPORT",
            "state": "RI",
            "postal_code": "028401724",
            "telephone_number": "207-318-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBEAULT",
        "first_name": "BRANDON",
        "middle_name": "RONALD",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-21",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "93042",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW03070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Talkspace",
            "affiliation": "Y",
            "affiliationName": "Talkspace Network LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "33 W 60th St Fl 8",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100237953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert James Sucsy, MD
• John Patrick Sullivan Jr., PSY.D.
• Mark V Sutherland, MD
• Julia Stockman Tassinari, M.D.
• Peppino E Tettey, M.D.
• Erin Thomas, BSN, RN
• Emily Jina Thompson Carrillo, MD
• Timothy J Thompson, PA
• Joshua Thone
• Thrivewell LLC

• Clinical Social Worker in Newport, RI
• Providers in Newport, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.