Provider Demographics
NPI:1568522340
Name:LEBLANC, STEPHANIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:LEBLANC
Suffix:
Gender:F
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:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-1214
Mailing Address - Country:US
Mailing Address - Phone:207-423-3255
Mailing Address - Fax:
Practice Address - Street 1:150 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2035
Practice Address - Country:US
Practice Address - Phone:207-369-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC87481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical