Healthcare Provider Details

I. General information

NPI: 1821215328
Provider Name (Legal Business Name): STEVEN WILDER LECLAIR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PLEASANT VIEW DR
GRAY ME
04039-9572
US

IV. Provider business mailing address

PO BOX 1140 25 PLEASANT VIEW DRIVE
GRAY ME
04039-1140
US

V. Phone/Fax

Practice location:
  • Phone: 207-428-3055
  • Fax: 207-428-3069
Mailing address:
  • Phone: 207-428-3055
  • Fax: 207-428-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS 743
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS 743
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS 743
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS 743
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS 743
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPS 743
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: