Nicole Thibodeau, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC17596 Issued in ME

Practice address

27 Washington St
Camden, ME 04843-1739

Phone

(207) 415-6363

NPI assigned

Dec 1, 2016

Last updated

Oct 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1710420211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 WASHINGTON ST",
            "city": "CAMDEN",
            "state": "ME",
            "postal_code": "048431739",
            "telephone_number": "207-415-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 WASHINGTON ST",
            "city": "CAMDEN",
            "state": "ME",
            "postal_code": "048431739",
            "telephone_number": "207-415-6363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "67 Captain Cushman Rd",
            "address_purpose": "LOCATION",
            "city": "Morrill",
            "state": "ME",
            "postal_code": "049525035",
            "country_code": "US",
            "telephone_number": "207-342-3655 x13",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "NICOLE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-01",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "MC16161",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC17596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Camden, ME
• Providers in Camden, 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 Oct 9, 2020; 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.