Kelly Thibodeau

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

329 Conway St Ste 1
Greenfield, MA 01301-1514

Phone

(413) 774-6301

NPI assigned

Jan 4, 2022

Last updated

May 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1649931429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 LITTLE MOHAWK RD",
            "city": "SHELBURNE FALLS",
            "state": "MA",
            "postal_code": "013709691",
            "telephone_number": "413-312-8979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 CONWAY ST STE 1",
            "city": "GREENFIELD",
            "state": "MA",
            "postal_code": "013011514",
            "telephone_number": "413-774-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-05-17",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Commonwealth of Massachusetts (Enter DBA name for your facility)
• The Community Young Men's Christian Association of Greenfield, Mass
• The Stop & Shop Supermarket Company, LLC (Stop and Shop Pharmacy #45)
• The United Arc of Franklin & Hampshire Co
• Nicholas Peter Theberge, DDS
• Sandra A Thomaier, NP, CNS
• Franklin R Thomas, M.D.
• Jonathan Thomas, LICSW
• Rene Michelle Thomas, OT
• Alexandra Thompson, BSW

• Behavior Technician in Greenfield, MA
• Providers in Greenfield, MA by specialty
• Behavior Technician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.