Provider Demographics
NPI:1104261460
Name:LETENDRE, PAUL J (LMHC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LETENDRE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LIBERTY SQ # 353
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:800-887-5718
Mailing Address - Fax:
Practice Address - Street 1:6 LIBERTY SQ # 353
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-5800
Practice Address - Country:US
Practice Address - Phone:800-887-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00729101YM0800X
FLMH19244101YM0800X
VA0701008982101YP2500X
CALPCC10669101YP2500X
MA9409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional