MEDICARE: DR. CATHERINE ANNE LE BLANC PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	016071-1	NY

General Provider Information

NPI Number	:	1417979378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE ANNE LE BLANC PHD

Provider Business Mailing Address
First Line	:	221 SANDPIPER CT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1968
Country	:	US
Telephone Number	:	914-245-3747
Fax Number	:	914-245-3747

Provider Business Practice Location Address
First Line	:	1884 RAILROAD AVE
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4406
Country	:	US
Telephone Number	:	914-245-4269
Fax Number	:	914-245-4270

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/08/2007

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