MEDICARE: JESSIE A NOTCH-LEBLANC LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	077981-R	NY
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255443719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE A NOTCH-LEBLANC LCSW

Provider Business Mailing Address
First Line	:	22 US OVAL STE 123
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5901
Country	:	US
Telephone Number	:	518-802-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 US OVAL STE 123
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5901
Country	:	US
Telephone Number	:	518-802-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/10/2024

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