Provider Demographics
NPI:1568670834
Name:LEBLANC, MICHAEL TAYLOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 RIDGELAKE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4966
Mailing Address - Country:US
Mailing Address - Phone:504-835-9387
Mailing Address - Fax:866-249-8075
Practice Address - Street 1:2901 RIDGELAKE DR
Practice Address - Street 2:STE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4966
Practice Address - Country:US
Practice Address - Phone:504-835-9387
Practice Address - Fax:866-249-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2517DOtherPIN BCBSLA