| Doctor Name: | MR. EDWARD JOSEPH THIBODEAU |
| NPI Number: | 1063485761 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSSA |
| License Number: | 44SC04888700 |
| Business Practice Address: | 5234 Overlook Ln Canandaigua, NY - 144249111 |
| Business Phone Number: | 5853319320 |
| Business Fax Number: | |
| Mailing Address: | 5234 Overlook Ln, CANANDAIGUA |
| State: | NY |
| Postal Code: | 144249111 |
| Phone Number: | 5853319320 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2006 |
| NPI Last Update Date: | 10/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC04888700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |