Active NPI
Moriah Irael Thibodeau, LCSW, LICSW
- Clinical Social Worker
- Hartford, CT
National Provider Identifier
1972125441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11705
- Practice address
- 80 Seymour St
Hartford, CT 06102-8000 - Phone
- (860) 972-4061
- NPI assigned
- May 7, 2020
- Last updated
- Feb 8, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 4925 | CT | |
| Clinical Social Worker | 1041C0700X | 124530 | MA | |
| Clinical Social Worker | 1041C0700X | 11705 | CT | Primary |
Addresses
Primary practice location
80 Seymour St
Hartford, CT 06102-8000
Mailing address
PO Box 5037
Hartford, CT 06102-5037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4925 | CT | MD | Professional Counselor |
| 124530 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707350400000",
"number": "1972125441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5037",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061025037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 SEYMOUR ST",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061028000",
"telephone_number": "860-972-4061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAU",
"first_name": "MORIAH",
"middle_name": "IRAEL",
"credential": "LCSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-07",
"last_updated": "2024-02-08",
"certification_date": "2024-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CT",
"license": "4925",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "124530",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "11705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.