Provider Demographics
NPI:1821215328
Name:LECLAIR, STEVEN WILDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WILDER
Last Name:LECLAIR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:25 PLEASANT VIEW DRIVE
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1140
Mailing Address - Country:US
Mailing Address - Phone:207-428-3055
Mailing Address - Fax:207-428-3069
Practice Address - Street 1:25 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9572
Practice Address - Country:US
Practice Address - Phone:207-428-3055
Practice Address - Fax:207-428-3069
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS 743103T00000X, 103TA0700X, 103TC0700X, 103TM1800X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation