Provider Demographics
NPI:1720010218
Name:PAQUETTE, LEEANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WEST AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6077
Mailing Address - Country:US
Mailing Address - Phone:518-560-9645
Mailing Address - Fax:
Practice Address - Street 1:120 WEST AVE STE 208
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6077
Practice Address - Country:US
Practice Address - Phone:518-560-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017628103TC0700X
VT048-0000705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03030568Medicaid
VT1006115Medicaid
VT1006115Medicaid
NYIA1412Medicare PIN
VTPAVN1642Medicare ID - Type UnspecifiedPSYCHOLOGIST