Basic Information
| Provider Information | |||||||||
| NPI: | 1881975480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE BLANC | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 ROYAL DANE LANE | ||||||||
| Address2: | APARTMENT 25 | ||||||||
| City: | ABINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023511740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787614442 | ||||||||
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| Practice Location | |||||||||
| Address1: | 37 BELMONT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085804691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.