Provider Demographics
NPI:1316401714
Name:LEBLANC, HOLLY M (BA, MS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HARTFORD AVE N
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1651
Mailing Address - Country:US
Mailing Address - Phone:617-291-5451
Mailing Address - Fax:
Practice Address - Street 1:51 MAPLE DELL LN
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2433
Practice Address - Country:US
Practice Address - Phone:617-291-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician