Jeannin Thibodeau, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC19797 Issued in ME

Practice address

30 Devotion Ave
Sanford, ME 04073

Phone

(207) 742-7264

NPI assigned

Mar 8, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1205967411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 PORTLAND RD",
            "address_2": "STE 7, #294",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040436660",
            "telephone_number": "207-742-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 DEVOTION AVE",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "04073",
            "telephone_number": "207-742-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "JEANNIN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "13316",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC19797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Synapse, LLC
• Michael Joseph Szura Jr., PT, DPT
• John Tederous Sr.
• Leonid I Temkin, MD
• Timothy A Theobald, DO
• Richard P Thompson, O.D.
• Richard S Tockman, MD
• Michael Josesph Toka, D.C.
• Lauren M Torch, LCSW
• Christina Tracy, LMSW-CC

• Clinical Social Worker in Sanford, ME
• Providers in Sanford, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.