Provider Demographics
NPI:1912285982
Name:THIBERT, DANIELLE A (LICSW)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:A
Last Name:THIBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 E MAIN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4263
Mailing Address - Country:US
Mailing Address - Phone:401-684-1787
Mailing Address - Fax:401-293-5282
Practice Address - Street 1:3047 E MAIN RD STE 4
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4263
Practice Address - Country:US
Practice Address - Phone:401-684-1787
Practice Address - Fax:833-339-3848
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical