Provider Demographics
NPI:1679529903
Name:LEBLANC, LISA M (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUMFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3845
Mailing Address - Country:US
Mailing Address - Phone:617-233-8707
Mailing Address - Fax:
Practice Address - Street 1:96 SUGAR RUN
Practice Address - Street 2:
Practice Address - City:FAYSTON
Practice Address - State:VT
Practice Address - Zip Code:05673-7245
Practice Address - Country:US
Practice Address - Phone:802-496-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00010871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical