Provider Demographics
NPI:1962831545
Name:LEDUC, MEAGAN A (PSYD CLINICAL PSYC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:A
Last Name:LEDUC
Suffix:
Gender:F
Credentials:PSYD CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DALE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-676-9350
Mailing Address - Fax:860-678-7178
Practice Address - Street 1:40 DALE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-676-9350
Practice Address - Fax:860-678-7178
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical