Provider Demographics
NPI:1356818397
Name:BORDEAU, LENORA M (MAAT, ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:LENORA
Middle Name:M
Last Name:BORDEAU
Suffix:
Gender:F
Credentials:MAAT, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 POWDER HORN RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6223
Mailing Address - Country:US
Mailing Address - Phone:412-952-2279
Mailing Address - Fax:
Practice Address - Street 1:5 POWDER HORN RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-6223
Practice Address - Country:US
Practice Address - Phone:412-952-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001496221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist