Provider Demographics
NPI:1073897021
Name:LECLAIR, PATRICIA L (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE STE 248
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2166
Mailing Address - Country:US
Mailing Address - Phone:831-425-3104
Mailing Address - Fax:
Practice Address - Street 1:820 BAY AVE STE 248
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2166
Practice Address - Country:US
Practice Address - Phone:831-425-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist