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General NPI Number Information
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NPI Number | 1679533673
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Entity Type | Individual
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Provider Name | MARK D. LESSARD PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | EBH02 4TH ARMORED DRIVE
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City | FORT DRUM
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State | NY
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Zip | 13602
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Country | US
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Telephone | 315-772-6703
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Fax |
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Provider Business Mailing Address
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Address Line | EBH02 4TH ARMORED DRIVE
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City | FORT DRUM
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State | NY
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Zip | 13602
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Country | US
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Telephone | 315-772-6703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2104-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3-1940
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 725
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License Number State | VT
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