Provider Demographics
NPI:1639147721
Name:LEBLANC, MARIA E (MED, MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MED, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RUSSELL ST STE 18B
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9563
Mailing Address - Country:US
Mailing Address - Phone:413-695-3707
Mailing Address - Fax:413-409-8965
Practice Address - Street 1:245 RUSSELL ST STE 18B
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9563
Practice Address - Country:US
Practice Address - Phone:413-695-3707
Practice Address - Fax:413-409-8965
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1105231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA775273730000OtherMAGELLAN BEHAVIORAL HEALT
MA248803OtherCOMPSYCH
MA329036OtherTRICARE/PGBA
MA1859340Medicaid
MAP08402OtherBLUE CROSS BLUE SHIELD
MA775273730000OtherMAGELLAN BEHAVIORAL HEALT