=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417979378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE ANNE LE BLANC PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1884 RAILROAD AVE
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-4406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-4269
-----------------------------------------------------
Fax | 914-245-4270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 SANDPIPER CT
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-245-3747
-----------------------------------------------------
Fax | 914-245-3747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 016071-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------