Provider Demographics
NPI:1285217802
Name:LEDUC, RACQUEL (MA , LBSC)
Entity Type:Individual
Prefix:MRS
First Name:RACQUEL
Middle Name:
Last Name:LEDUC
Suffix:
Gender:F
Credentials:MA , LBSC
Other - Prefix:
Other - First Name:RACQUEL
Other - Middle Name:
Other - Last Name:LEDUC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1175 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4026
Mailing Address - Country:US
Mailing Address - Phone:215-681-0704
Mailing Address - Fax:
Practice Address - Street 1:27 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19119-1713
Practice Address - Country:US
Practice Address - Phone:215-248-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional