Healthcare Provider Details

I. General information

NPI: 1245452317
Provider Name (Legal Business Name): MARY-ELIZABETH VASCONCELLOS LEBLANC LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 STATE RD
NORTH DARTMOUTH MA
02747-2923
US

IV. Provider business mailing address

106 STATE RD
NORTH DARTMOUTH MA
02747-2923
US

V. Phone/Fax

Practice location:
  • Phone: 774-264-3555
  • Fax: 857-317-8403
Mailing address:
  • Phone: 774-264-3555
  • Fax: 857-317-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: