Provider Demographics
NPI:1215569959
Name:LECLERC, VICTOR R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:R
Last Name:LECLERC
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PARK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7282
Mailing Address - Country:US
Mailing Address - Phone:207-330-5395
Mailing Address - Fax:207-782-9001
Practice Address - Street 1:95 PARK ST STE 201
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7282
Practice Address - Country:US
Practice Address - Phone:207-330-5395
Practice Address - Fax:207-782-9001
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC13570101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor