Provider Demographics
NPI:1184137143
Name:LEBLANC, KELSEY REYNOLDS (MED, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:REYNOLDS
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MED, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1806
Mailing Address - Country:US
Mailing Address - Phone:203-980-4357
Mailing Address - Fax:
Practice Address - Street 1:62 ELM ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1806
Practice Address - Country:US
Practice Address - Phone:203-980-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst