Provider Demographics
NPI:1922149459
Name:LE BLANC, WAYNE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ROBERT
Last Name:LE BLANC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 SOUTH ST
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2329
Mailing Address - Country:US
Mailing Address - Phone:845-680-7876
Mailing Address - Fax:
Practice Address - Street 1:140 OLD ORANGEBURG RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1157
Practice Address - Country:US
Practice Address - Phone:845-680-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical