MEDICARE: MAUREEN ELIZABETH LEBLANC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1063267417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN ELIZABETH LEBLANC

Provider Business Mailing Address
First Line	:	5507 NESCONSET HWY
Second Line	:	SUITE 10 PMB 339
City	:	MT. SINAI
State	:	NY
Zip	:	11766
Country	:	US
Telephone Number	:	631-502-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-509-3681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	06/03/2026

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