Provider Demographics
NPI:1396953543
Name:LECLAIR, SUSAN SOLANGE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SOLANGE
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE STE 101 B
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1544
Mailing Address - Country:US
Mailing Address - Phone:860-231-7991
Mailing Address - Fax:860-231-7991
Practice Address - Street 1:836 FARMINGTON AVE STE 101 B
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1544
Practice Address - Country:US
Practice Address - Phone:860-231-7991
Practice Address - Fax:860-231-7991
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist