Provider Demographics
NPI:1568471167
Name:LEBLANC, CAROL LEE (PH D LCSW)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PH D LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2122
Mailing Address - Country:US
Mailing Address - Phone:207-766-2836
Mailing Address - Fax:
Practice Address - Street 1:6 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2122
Practice Address - Country:US
Practice Address - Phone:207-766-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1145103TC0700X
MELC53331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100339OtherANTHEM BEHAVIORAL HEALTH
LEMN5517Medicare ID - Type Unspecified