Healthcare Provider Details

I. General information

NPI: 1629681762
Provider Name (Legal Business Name): YVETTE LEBLANC M.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL DEPT OF
BOSTON MA
02118-2908
US

IV. Provider business mailing address

801 ALBANY ST ENROLLMENT OFFICE
BOSTON MA
02119-3791
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5245
  • Fax: 617-414-5520
Mailing address:
  • Phone: 617-414-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12292
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: