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General NPI Number Information
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NPI Number | 1841772324
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Entity Type | Individual
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Provider Name | EVAN ALDEN LECLAIR LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 12/15/2018
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Provider Practice Location Address
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Address Line | 16 HILLSIDE AVE
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City | NAUGATUCK
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State | CT
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Zip | 06770-4019
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Country | US
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Telephone | 774-406-4924
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Fax |
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Provider Business Mailing Address
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Address Line | 174 KNOLLWOOD DR
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City | WALLINGFORD
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State | CT
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Zip | 06492-2997
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Country | US
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Telephone | 203-443-7842
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58.010209
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License Number State | CT
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