NPIMap

Organization Active NPI

John R Thibodeau LLC

  • Clinical Psychologist
  • Longwood, FL
National Provider Identifier
1417183419
Registry record updated Jun 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY 7684 Issued in FL
Legal business name
JOHN R THIBODEAU LLC
Practice address
296 New Waterford PL
Longwood, FL 32779-5656
Phone
(321) 972-5693
Fax
(321) 972-5693
NPI assigned
Jun 4, 2009
Last updated
Jun 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2009

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

Authorized official

Name
Dr. John R. Thibodeau, PH.D.NPI 1962506188
Title
Sole Member
Phone
(321) 972-5693

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY 7684 FL Primary

Addresses

Primary practice location

296 New Waterford PL
Longwood, FL 32779-5656

Mailing address

296 New Waterford PL
Longwood, FL 32779-5656
Phone (321) 972-5693

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1417183419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 NEW WATERFORD PL",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327795656",
            "telephone_number": "321-972-5693",
            "fax_number": "321-972-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 NEW WATERFORD PL",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327795656",
            "telephone_number": "321-972-5693",
            "fax_number": "321-972-5693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R THIBODEAU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-04",
        "last_updated": "2009-06-04",
        "status": "A",
        "authorized_official_last_name": "THIBODEAU",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "321-972-5693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 7684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; 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.