Provider Demographics
NPI:1598830986
Name:LEBLANC, ANGELA LEE (MA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PONTIAC RD
Mailing Address - Street 2:#7
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2477
Mailing Address - Country:US
Mailing Address - Phone:508-776-0179
Mailing Address - Fax:
Practice Address - Street 1:400 NATHAN ELLIS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3143
Practice Address - Country:US
Practice Address - Phone:508-477-5488
Practice Address - Fax:508-477-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health